超声在胎儿肺静脉异位引流诊断中的应用价值

Value of ultrasound in diagnosis of fetal anomalous pulmonary venous connection

目的探讨超声在诊断胎儿肺静脉异位引流(APVC)中的应用价值。方法选取2018年9月至2021年8月在承德医学院附属医院产前超声诊断为APVC的胎儿32例,排除右心房异构畸形。所有病例经分娩后新生儿超声心动检查和引产后尸检证实。产前超声评估胎儿各项生长发育指标和各系统发育,重点检查胎儿心脏,尤其是肺静脉。新生儿超声心动图常规检查各切面,重点观察肺静脉情况。尸检主要观察心脏、大血管位置及肺静脉汇入情况。结果产前超声诊断APVC 32例,其中完全性肺静脉异位引流(TAPVC)28例,部分性肺静脉异位引流(PAPVC)4例。产后超声证实产前超声正确诊断11例,其中TAPVC 8例,PAPVC 3例,误诊PAPVC 1例,漏诊6例,其中TAPVC 3例,PAPVC 3例。引产后尸检证实产前超声正确诊断20例。TAPVC中左心房内未见明显肺静脉开口21例(75.0%),探及共同腔28例(100%),探及垂直静脉及完整回流路径24例(85.7%),左心房后壁空间指数大于截断值20例(71.4%),引流血管扩张15例(53.6%)。4例PAPVC中可探及垂直静脉1例(25.0%),单支肺静脉于右心房顶部直接汇入右心房3例(75.0%)。产前超声对TAPVC检测的准确性、敏感度和漏诊率分别为90.3%(28/31),90.3%(28/31),9.7%(3/31)。产前超声对PAPVC检测的准确性、敏感度和漏诊率分别为42.9%(3/7),50.0%(3/6),50.0%(3/6)。11例TAPVC病例中8例合并其他心脏畸形。20例引产病例中孤立性TAPVC 5例,合并其他先天性心脏畸形15例。2例TAPVC患儿于新生儿期死亡,9例经手术治疗恢复良好。6例PAPVC患儿中1例合并室间隔缺损,其余为孤立性。结论超声对诊断APVC具有良好的应用价值,但PAPVC的诊断难度仍较大。

Objective To assess the value of ultrasound in the diagnosis of fetal anomalous pulmonary venous connection(APVC).Methods Thirty-two cases of fetal APVC diagnosed by prenatal ultrasound at the Affiliated Hospital of Chengde Medical University from September 2018 to August 2021 were selected,with right atrial isomerism excluded.All cases were confirmed by postnatal neonatal ultrasound cardiac examination and autopsy after delivery.Prenatal ultrasound assessed various fetal growth and development parameters,as well as systemic development,with a focus on fetal heart,especially the pulmonary veins.Routine echocardiographic examinations were performed on the newborns,with a particular focus on the pulmonary veins.Autopsy was performed to mainly observe the heart,the position of major blood vessels,and the status of pulmonary vein drainage.Results Prenatal ultrasound diagnosed APVC in 32 cases,including 28 cases of total APVC(TAPVC)and 4 cases of partial APVC(PAPVC).Postnatal ultrasound confirmed the prenatal ultrasound diagnosis in 11 cases,including 8 cases of TAPVC and 3 cases of PAPVC.There was 1 case of misdiagnosed PAPVC and 6 cases of missed diagnosis,including 3 cases of TAPVC and 3 cases of PAPVC.Autopsy confirmed the prenatal ultrasound diagnosis in 20 cases.Among the TAPVC cases,21(75.0%)showed no obvious opening of the pulmonary veins in the left atrium,28(100%)had a common chamber,24(85.7%)had vertical veins and complete return pathways,20(71.4%)had a posterior left atrial wall space index greater than the cutoff value,and 15(53.6%)had dilated drainage vessels.Among the 4 cases of PAPVC,1(25.0%)had detectable vertical veins,and 3(75.0%)had a single pulmonary vein directly draining into the top of the right atrium.The accuracy,sensitivity,and missed diagnosis rate of prenatal ultrasound for detecting TAPVC were 90.3%(28/31),90.3%(28/31),and 9.7%(3/31),respectively.The accuracy,sensitivity,and missed diagnosis rate of prenatal ultrasound for detecting PAPVC were 42.9%(3/7),50.0%(3/6),and 50.0%(3/6),respectively.Among the 11 cases of TAPVC,8 were associated with other cardiac malformations.Among the 20 cases of induced labor,5 had isolated TAPVC,and 15 had combined other congenital heart malformations.Two cases of TAPVC died in the neonatal period,and 9 cases recovered well after surgical treatment.Among the 6 cases of PAPVC,1 was associated with a ventricular septal defect,and the rest were isolated.Conclusion Ultrasound has good application value in the diagnosis of APVC,but the diagnosis of PAPVC remains challenging.