胎儿三血管气管切面动脉导管弓左侧血管的鉴别诊断

Differential diagnosis of the vessel locating on the left side of ductus arteriosus arch in fetal three-vessel and trachea view

目的:探讨三血管气管切面(three-vessel trachea view, 3VT)动脉导管弓(ductus arteriosus arch,DAA)左侧血管的超声鉴别诊断流程、主要切面和鉴别要点。方法:回顾性分析我院胎儿心脏超声检查过程中,3VT切面于DAA左侧探及血管的胎儿34例。总结形成DAA左侧血管的疾病类型,归纳鉴别诊断的流程、主要切面和鉴别要点。所有病例均采用出生后新生儿心脏超声证实。结果:(1)根据形成3VT切面DAA左侧血管的病因,将研究对象分为五组:双侧上腔静脉组21例(bilateral superior vena cava, BSVC, 61.8%)、孤立性永存左上腔静脉组2例(isolated left superior vena cava, ILSVC, 5.9%)、左无名静脉弓下走行组3例(subaortic left brachiocephalic vein, SLBCV, 8.8%)、心上型肺静脉异位引流的垂直静脉组3例(vertical vein, VV, 8.8%)和动脉导管壁瘤样膨出组5例(aneurysm of ductus arteriosus, ADA,14.7%)。(2) BSVC鉴别要点是左上腔静脉回流至冠状静脉窦或左心房;ILSVC鉴别要点是仅探及左上腔静脉,右上腔静脉缺如;SLBCV鉴别要点是左无名静脉从主动脉弓下穿行;VV鉴别要点是VV血流方向为从下至上,背离心脏;ADA鉴别要点是动脉导管壁呈瘤样膨出,其频谱为动脉频谱。结论:胎儿3VT切面上DAA左侧血管的鉴别诊断包括BSVC、ILSVC、SLBCV、VV和ADA。超声医师掌握各个疾病的鉴别诊断流程和鉴别要点有助于提高对相关畸形的产前检出和诊断能力。

Objective:To explore the flow chart,ultrasound views and key points(KP)of differential diagnosis of vessel locating on the left side of ductus arteriosus arch(DAA)in three-vessel trachea view(3VT).Methods:A retrospective analysis was performed on 34 fetuses,whom were detected a vessel locating on the left side of DAA in 3VT view during fetal heart examination by ultrasound in our hospital.Then,the flow chart,ultrasound views,scanning skills and key points of differential diagnosis of various types of diseases were analyzed.All diagnosis were confirmed by postnatal neonatal cardiac ultrasound.Results:①According to the causes forming the vessel on the left side of DAA in 3VT,the subjects were divided into:twenty-one cases with bilateral superior vena cava(BSVC,61.8%),2 cases with isolated left superior vena cava(ILSVC,5.9%),3 cases with subaortic left brachiocephalic vein(SLBCV,8.8%),3 cases with vertical vein of ectopic cardiac pulmonary vein drainage(VV,8.8%),and 5 cases with aneurysm of ductus arteriosus(ADA,14.7%).②The KP for differential diagnosis of each type of disease were as the following:The KP for BSVC was the connection of left SVC with coronary sinus or left atrium.The KP for ILSVC was the connection of left SVC with coronary sinus or left atrium,and the absence of right SVC.The KP for SLBCV was that LBCV located under the aortic arch.The KP for VV was that the blood flow within VV was away from the heart.The KP for ADA was that its spectrum was arterial pulsation spectrum.Conclusions:The differential diagnosis of the vessel locating on the left side of DAA in fetal 3VT view includes BSVC,ILSVC,SLBCV,VV and ADA.Mastering the rules is helpful for doctors to improve the prenatal detection and diagnosing rate of related malformations.