胎儿三尖瓣反流超声表现及其可能病因

Ultrasonic manifestations and possible etiology of fetal tricuspid regurgitation

目的观察胎儿三尖瓣反流(TR)超声表现及其可能病因。方法回顾性分析717胎产前超声诊断TR胎儿,观察其超声表现;根据产后随访所见将其分为生理性TR组(n=468)与病理性TR组(n=249),再以可能病因将后者分为右心前负荷增加亚组(n=76)、右心后负荷增加亚组(n=127)及三尖瓣结构异常亚组(n=46),对比分析其超声表现。结果生理性TR组包括441胎(441/468,94.23%)轻度及27胎(27/468,5.77%)中度TR,未见重度TR。病理性TR组3个亚组间TR程度差异有统计学意义(χ^(2)=37.244,P<0.001);轻度TR多见于右心前负荷增加亚组,而中、重度TR则多见于其他2个亚组。右心前负荷增加亚组中,永存左上腔静脉胎儿更易发生轻度TR;右心后负荷增加亚组中,室间隔完整型肺动脉闭锁胎儿更易发生重度TR(P均<0.05);上述2个亚组内不同可能病因胎儿TR程度差异均无统计学意义(P均>0.05)。三尖瓣结构异常亚组内不同可能病因胎儿TR程度差异有统计学意义(P<0.05),三尖瓣发育不良胎儿更易发生重度反流(P<0.05)。3个亚组间中、重度TR反流速度差异有统计学意义(F=6.945,P=0.002)。结论胎儿TR多为生理性。胎儿病理性TR常见可能病因包括肺动脉瓣狭窄、永存左上腔静脉及三尖瓣发育不良等,其产前超声表现有所差异。

Objective To observe the ultrasonic manifestations and possible etiology of fetal tricuspid regurgitation(TR).Methods Totally 717 fetuses diagnosed with TR by prenatal ultrasound were retrospectively enrolled,and the prenatal ultrasonic findings were observed.Based on postpartum follow-up data,the fetuses were divided into physiological TR group(n=468)and pathological TR group(n=249),and those in the latter were further divided into right heart preload increase subgroup(n=76),right heart afterload increase subgroup(n=127)and tricuspid valve structure abnormality subgroup(n=46)according to the possible etiology,and the ultrasonic manifestations were comparatively analyzed.Results In physiological TR group,mild and moderate TR was found in 441(441/468,94.23%)and 27 fetuses(27/468,5.77%),respectively,while no severe TR was noticed.In pathological TR group,significant difference of TR degrees was found among 3 subgroups(χ^(2)=37.244,P<0.001).Mild TR was more common in right heart preload increase subgroup,while moderate and severe TR were more common in the other 2 subgroups.In right heart preload increase subgroup,fetuses with persistent left superior vena cava were more likely to develop mild TR,while those with intact interventricular septum and pulmonary artery occlusion were more likely to develop severe TR in right heart afterload increase subgroup(both P<0.05).No significant difference of TR degree was found among fetuses with different possible etiology in right heart preload increase subgroup nor right heart afterload increase subgroup(both P>0.05).In tricuspid valve structure abnormality subgroup,significant differences of TR degrees were found among fetuses with different possible etiologies(P<0.05),and fetuses with underdeveloped tricuspid valve were more prone to severe reflux(P<0.05).There were significant differences of reflux velocity of moderate and severe TR among 3 subgroups(F=6.945,P=0.002).Conclusion Fetal TR was mostly physiological.The possible etiologies of pathological TR were variable,including pulmonary valve stenosis,persistent left superior vena cava and tricuspid valve hypoplasia,with different prenatal ultrasonic manifestations.