目的:研究并探讨产前超声检查在胎儿卵圆孔血流受限或提前闭合(foramen ovale restriction or closure,FO-R/C)中的诊断价值。方法:选取6例FO-R/C胎儿作为观察组,分析总结其影像学资料以及妊娠结局,同时选取6例正常胎儿作为对照组,比较...目的:研究并探讨产前超声检查在胎儿卵圆孔血流受限或提前闭合(foramen ovale restriction or closure,FO-R/C)中的诊断价值。方法:选取6例FO-R/C胎儿作为观察组,分析总结其影像学资料以及妊娠结局,同时选取6例正常胎儿作为对照组,比较两组胎儿的心脏大小、心胸比、主肺动脉与肺动脉内径比值、肺动脉瓣上与主动脉瓣上血流速度比值。结果:观察组中有4例卵圆孔内径<3 mm,2例胎儿卵圆孔接近闭合;经测定观察组所有胎儿均存在三尖瓣反流情况,其中2例胎儿分别合并有腹腔积液及心包腔积液;观察组及对照组胎儿的心胸比、右房内径/左房内径值、右室内径/左室内径值、主肺动脉内径/肺动脉内径值、肺动脉瓣上/主动脉瓣上血流流速比等各项指标均存在差异,且差异具有统计学意义(P<0.05)。结论:产前超声检查能够为孕中晚期FO-R/C的诊断提供一定的参考,加强胎儿FO-R/C早期诊断能够提高其存活率,促进预后。展开更多
[Objectives] This study was conducted to better understand the characteristics of the fetal blood circulation. [Methods] The cardiac opening of the inferior vena cava was observed in goat fetuses. There are two cardia...[Objectives] This study was conducted to better understand the characteristics of the fetal blood circulation. [Methods] The cardiac opening of the inferior vena cava was observed in goat fetuses. There are two cardiac openings of the inferior vena cava, namely, the foramen ovale with the valves and the right atrium opening of the inferior vena cava. The blood from the inferior vena cava moves easily into the right atrium via the right atrium opening because the right atrium opening without the valves is located in the lower right of the foramen ovale, and is bigger than the interatrial foramen. [Results] The blood may flow into the left atrium through the foramen ovale when the blood volume into the right atrium exceeds the limit of the right atrium. The fetal inferior vena cava compared with after birth receives oxygenated blood in the umbilical vein from the placenta besides the normal blood. Accordingly the blood volume into the right atrium exceeds the limit of the right atrium. Extra oxygenated blood is diverted directly into the left atrium through the foramen ovale. [Conclusions] This study provides a reference for studying the blood circulation of fetuses and even adults.展开更多
目的应用胎儿超声心动图定量分析卵圆孔瓣运动规律以及卵圆孔瓣宫内早闭的血流动力学特点。方法选取2019年11月至2020年6月在北京百子湾和美妇儿医院进行产前检查,胎儿及母体均未发现异常的孕妇102例为正常组,依据孕龄将正常组分为3组:...目的应用胎儿超声心动图定量分析卵圆孔瓣运动规律以及卵圆孔瓣宫内早闭的血流动力学特点。方法选取2019年11月至2020年6月在北京百子湾和美妇儿医院进行产前检查,胎儿及母体均未发现异常的孕妇102例为正常组,依据孕龄将正常组分为3组:组A孕28^(+0)~32^(+6)周36例,组B孕33^(+0)~36^(+6)周32例,组C孕37^(+0)~40^(+6)周34例。另选取超声心动图诊断为胎儿宫内卵圆孔瓣早闭且右心增大的孕妇14例为异常组。应用M型超声心动图检测胎儿卵圆孔瓣运动曲线,测量收缩期(S峰)和舒张期(D峰)运动峰值,S峰持续时间(ST),1个心动周期持续时间(T),S峰下降斜率,计算ST/T;应用多普勒超声测量肺动脉瓣、主动脉瓣、动脉导管血流速度,静脉导管阻力指数,脐静脉(腹段)血流速度,跨卵圆孔和下腔静脉入右心房血流速度;应用二维超声测量胎儿卵圆孔径,右心房与左心房横径比值(RA/LA)、右心室与左心室横径比值(RV/LV)。比较并分析各组之间以上参数的差异。结果正常组胎儿卵圆孔瓣M型超声心动图特点为卵圆孔瓣运动曲线形成的S峰和D峰皆为向左心房单向运动,S峰最大运动峰值大于D峰。正常胎儿S峰最大运动峰值5~7 mm,平均(6.00±0.96)mm。M型超声心动图测量卵圆孔瓣运动曲线S峰运动最大峰值,卵圆孔瓣早闭组与正常组C比较差异有统计学意义[(3.72±0.54)cm vs(6.17±0.94)cm,P<0.001],ST/T卵圆孔瓣早闭组较正常组C减小,差异有统计学意义(0.52±0.86 vs 0.59±0.05,P<0.001)。卵圆孔瓣早闭组胎儿右心扩大,与正常组C比较,RA/LA增大,2组间差异有统计学意义(1.83±0.21 vs 1.19±0.19,P<0.001)。正常胎儿跨卵圆孔血流速度低于下腔静脉入口血流速度[(40.9±8.9)cm/s vs(52.5±11.5)cm/s,P<0.05],卵圆孔瓣早闭组跨卵圆孔血流速度高于下腔静脉入口血流速度[(47.9±10.6)cm/s vs(43.1±7.4)cm/s,P<0.05]。脐静脉血流速度正常组C高于卵圆孔瓣早闭组,差异有统计学意义[(24.4±4.47)cm/s vs(20.3±5.00)cm/s,P<0.05]。结论M型超声心动图显示正常胎儿卵圆孔瓣运动曲线有其自身规律和特点,卵圆孔瓣宫内早闭胎儿卵圆孔瓣开放运动减低。应用M型超声心动图对卵圆孔瓣运动及血流动力学特点进行定量分析研究,有助于准确诊断卵圆孔瓣宫内闭合。展开更多
基金Supported by the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)Scientific Research Fund of Nanjing General Hospital of Nanjing Military Command,China(2016033)
文摘[Objectives] This study was conducted to better understand the characteristics of the fetal blood circulation. [Methods] The cardiac opening of the inferior vena cava was observed in goat fetuses. There are two cardiac openings of the inferior vena cava, namely, the foramen ovale with the valves and the right atrium opening of the inferior vena cava. The blood from the inferior vena cava moves easily into the right atrium via the right atrium opening because the right atrium opening without the valves is located in the lower right of the foramen ovale, and is bigger than the interatrial foramen. [Results] The blood may flow into the left atrium through the foramen ovale when the blood volume into the right atrium exceeds the limit of the right atrium. The fetal inferior vena cava compared with after birth receives oxygenated blood in the umbilical vein from the placenta besides the normal blood. Accordingly the blood volume into the right atrium exceeds the limit of the right atrium. Extra oxygenated blood is diverted directly into the left atrium through the foramen ovale. [Conclusions] This study provides a reference for studying the blood circulation of fetuses and even adults.
文摘目的应用胎儿超声心动图定量分析卵圆孔瓣运动规律以及卵圆孔瓣宫内早闭的血流动力学特点。方法选取2019年11月至2020年6月在北京百子湾和美妇儿医院进行产前检查,胎儿及母体均未发现异常的孕妇102例为正常组,依据孕龄将正常组分为3组:组A孕28^(+0)~32^(+6)周36例,组B孕33^(+0)~36^(+6)周32例,组C孕37^(+0)~40^(+6)周34例。另选取超声心动图诊断为胎儿宫内卵圆孔瓣早闭且右心增大的孕妇14例为异常组。应用M型超声心动图检测胎儿卵圆孔瓣运动曲线,测量收缩期(S峰)和舒张期(D峰)运动峰值,S峰持续时间(ST),1个心动周期持续时间(T),S峰下降斜率,计算ST/T;应用多普勒超声测量肺动脉瓣、主动脉瓣、动脉导管血流速度,静脉导管阻力指数,脐静脉(腹段)血流速度,跨卵圆孔和下腔静脉入右心房血流速度;应用二维超声测量胎儿卵圆孔径,右心房与左心房横径比值(RA/LA)、右心室与左心室横径比值(RV/LV)。比较并分析各组之间以上参数的差异。结果正常组胎儿卵圆孔瓣M型超声心动图特点为卵圆孔瓣运动曲线形成的S峰和D峰皆为向左心房单向运动,S峰最大运动峰值大于D峰。正常胎儿S峰最大运动峰值5~7 mm,平均(6.00±0.96)mm。M型超声心动图测量卵圆孔瓣运动曲线S峰运动最大峰值,卵圆孔瓣早闭组与正常组C比较差异有统计学意义[(3.72±0.54)cm vs(6.17±0.94)cm,P<0.001],ST/T卵圆孔瓣早闭组较正常组C减小,差异有统计学意义(0.52±0.86 vs 0.59±0.05,P<0.001)。卵圆孔瓣早闭组胎儿右心扩大,与正常组C比较,RA/LA增大,2组间差异有统计学意义(1.83±0.21 vs 1.19±0.19,P<0.001)。正常胎儿跨卵圆孔血流速度低于下腔静脉入口血流速度[(40.9±8.9)cm/s vs(52.5±11.5)cm/s,P<0.05],卵圆孔瓣早闭组跨卵圆孔血流速度高于下腔静脉入口血流速度[(47.9±10.6)cm/s vs(43.1±7.4)cm/s,P<0.05]。脐静脉血流速度正常组C高于卵圆孔瓣早闭组,差异有统计学意义[(24.4±4.47)cm/s vs(20.3±5.00)cm/s,P<0.05]。结论M型超声心动图显示正常胎儿卵圆孔瓣运动曲线有其自身规律和特点,卵圆孔瓣宫内早闭胎儿卵圆孔瓣开放运动减低。应用M型超声心动图对卵圆孔瓣运动及血流动力学特点进行定量分析研究,有助于准确诊断卵圆孔瓣宫内闭合。
