胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用

Echocardioimagedata characteristics of fetal isolated total anomalous pulmonary venous connection and application of high definition flow imaging and spatio-temporal image correlation

目的分析胎儿孤立性完全型肺静脉异位引流(TAPVC)的二维灰阶及彩色多普勒超声心动图特征,探讨四维超声时间-空间相关成像(STIC)及高分辨率血流成像(HD-flow)在产前诊断孤立性TAPVC中的应用。方法本研究回顾性纳入广西壮族自治区妇幼保健院产前诊断的孤立性TAPVC 16例。其中2016年1月至2018年1月应用二维灰阶及彩色多普勒超声诊断9例;2018年2月至2021年3月,在二维超声心动图基础上应用四维STIC HD-flow诊断7例。均通过超声直接与间接征象对孤立性胎儿TAPVC进行筛查诊断,并对其预后结局进行随访。结果16例胎儿中,心上型12例(12/16),心内型2例(2/16),心下型2例(2/16)。8例(8/16)首先由直接征象发现,表现为四腔心切面未显示肺静脉与左心房相连,而汇合成共同腔。8例(8/16)首先由间接征象发现,其中冠状静脉窦扩张2例,三血管气管切面出现垂直静脉或上腔静脉增宽5例,肝门区域显示异常血管1例。7例四维STIC HD-flow重建图像均显示了4条肺静脉与共同腔相连,通过垂直静脉或冠状静脉窦汇入体静脉(右心房)。结论产前二维灰阶及彩色多普勒超声心动图直接征象与间接征象联合更有助于诊断孤立性胎儿TAPVC,四维STIC HD-flow可为胎儿TAPVC的诊断提供更多有价值的信息。

Objective To analyze the two-dimensional gray scale and color Doppler echocardiography characteristics of fetal isolated complete pulmonary venous drainage(TAPVC),and to explore the application of four-dimensional time-space correlation imaging(STIC)and high definition flow imaging(HD-flow)in the prenatal diagnosis of isolated TAPVC.Methods A retrospective analysis was performed on 16 cases of fetal isolated TAPVC at Guangxi in Maternity&Child Healthcare Hospital.Nine cases were diagnosed by two-dimensional gray scale and color Doppler echocardiography from January 2016 to January 2018,and seven cases were diagnosed based on two-dimensional echocardiography and four-dimensional STIC and HD-flow from February 2018 to March 2021.All of the above cases were both diagnosed by direct and indirect ultrasonography signs,and all cases were followed up.Results The study included supracardiac type TAPVC in 12(12/16)cases,cardiac type in 2(2/16),and infracardiac type in 2(2/16).Eight cases were found with direct ultrasound signs.Eight cases were found with indirect signs,including coronary sinus dilation in 2 cases,vertical vein or superior vena cava widening in 5,and abnormal blood vessels in the hilar area of the liver in 1.The four-dimensional STIC/HD-flow reconstruction images of 7 cases all showed that the 4 pulmonary veins were connected to the common pulmonary vein and joined into the systemic vein through vertical veins or the coronary sinus(right atrium).Conclusions The combination of direct and indirect signs of prenatal two-dimensional gray scale and color Doppler echocardiography is more helpful for the diagnosis of isolated fetal TAPVC,and four-dimensional STIC/HD-flow can provide more valuable information.