孕中期三血管气管切面联合肺动脉主干增宽指导胎儿心脏畸形诊断的价值

Value of ultrasound three-vessel trachea view combined with pulmonary artery trunk widening in the second trimester of pregnancy on guiding the diagnosis of fetal heart malformations

目的:探究孕中期超声三血管气管切面(3VT)联合肺动脉主干增宽对胎儿心脏畸形的诊断价值。方法:收集2022年1月—2023年6月于我院产检及分娩的胎儿心脏畸形产妇140例的临床资料,所有产妇均接受了产前系统超声检查,统计受试者孕中期超声检查结果,分析超声3VT联合肺动脉主干增宽对胎儿心脏畸形的诊断价值。结果:140例胎儿心脏畸形经孕中期超声诊断法洛四联症36例(25.71%),右室双出口15例(10.71%),主动脉缩窄26例(18.57%),主动脉弓离断4例(2.86%),双主动脉弓4例(2.86%),肺动脉狭窄20例(14.29%),永存左上腔静脉5例(3.57%),永存动脉干5例(3.57%),动脉导管迂回12例(8.57%),右位主动脉弓伴右位动脉导管4例(2.86%),右位主动脉弓伴左位动脉导管4例(2.86%),左心发育不良5例(3.57%)。随访140例心脏畸形胎儿中134例(95.71%)与孕中期超声诊断相符,2例永存动脉干未检出;右室双出口伴大动脉转位2例未检出;主动脉缩窄1例肢体短小未检出,1例单心室未检出。140例胎儿经临床确诊存在肺动脉瓣狭窄20例,肺动脉瓣缺如3例,特发性肺动脉扩张12例,特发性肺动脉高压18例,以肺动脉内径/主动脉内径(PA/AO)>1.2作为依据,共检出48例畸形,检出率为90.57%;140例胎儿心脏畸形孕中期3VT诊断正确134例,符合率为95.71%,联合PA/AO比值>1.2诊断正确137例,符合率为97.86%。两者联合诊断胎儿心脏畸形的符合率略高于肺动脉主干增宽检查及孕中期3VT检查单独诊断,但三者组间对比差异无统计意义(P>0.05)。结论:孕中期超声3VT联合肺动脉主干增宽对胎儿心脏畸形具有较高的诊断价值。

Objective:To explore the diagnostic value of ultrasound three-vessel trachea view(3VT)combined with pulmonary artery trunk widening in the second trimester of pregnancy on fetal heart malformations.Methods:Clinical data of140 puerperae with fetal heart malformations who performed antenatal examination and delivered in our hospital were collected from January 2022 to June 2023.All puerperae received prenatal systematic ultrasound examination.The ultrasonography results of the subjects in the second trimester of pregnancy were counted to analyze the diagnostic value of ultrasound 3VT combined with pulmonary artery trunk widening on fetal heart malformations.Results:Among 140 cases of fetal heart malformations,ultrasound diagnosis in the second trimester of pregnancy revealed 36 cases(25.71%)of tetralogy of fallot,15 cases(10.71%)of double-outlet right ventricle,26 cases(18.57%)of coarctation of aortic arch,4 cases(2.86%)of interruption of aortic arch,4 cases(2.86%)of double aortic arch,20 cases(14.29%)of pulmonary artery stenosis,5 cases(3.57%)of persistent left superior vena cava,5 cases(3.57%)of persistent truncus arteriosus,12 cases(8.57%)of ductus arteriosus circuity,4 cases(2.86%)of right aortic arch and right ductus arteriosus,4 cases(2.86%)of right aortic arch and left ductus arteriosus and 5cases(3.57%)of left heart dysplasia,and 134(95.71%)of 140 cases with cardiac malformations during follow-up were consistent with ultrasound diagnosis in the second trimester of pregnancy and 2 cases of persistent truncus arteriosus were not detected.Double-outlet right ventricle with transposition of the great arteries was not detected in 2 cases.Aortic arch coarctation was not detected in 1 case of short limbs and 1 case of single ventricle.There were 20 cases of pulmonary valve stenosis,3cases of pulmonary valve absence,12 cases of idiopathic pulmonary artery dilatation and 18 cases of idiopathic pulmonary hypertension in 140 fetuses by clinical diagnosis.Based on pulmonary artery/aorta(PA/AO)ratio>1.2,48 cases of malformations were detected,with the detection rate of 90.57%.Among 140 cases of fetal heart malformations,134 cases were diagnosed correctly by 3VT in the second trimester,with the coincidence rate of 95.71%;137 cases were diagnosed correctly by combining with PA/AO ratio>1.2,with the coincidence rate of 97.86%.The coincidence rate of combined diagnosis of fetal cardiac malformations was slightly higher than that of pulmonary artery trunk widening examination or 3VT examination in the second trimester,but there was no statistical significance among the three methods(P>0.05).Conclusion:Ultrasound 3VT combined with pulmonary artery trunk widening in the second trimester of pregnancy has high diagnostic value on fetal heart malformations.