室间隔完整的肺动脉闭锁的产前超声诊断  

Prenatal Ultrasonographic Diagnosis of Pulmonary Atresia with Intact Ventricular Septum

作　　者：陈琮瑛[1] 李胜利[1] 刘菊玲[1] 文华轩[1] 毕静茹[1] 官勇[1] 廖玉媚[1] 杨晓东[1] 

机构地区：[1]深圳市妇幼保健院超声科,广东省深圳市518028

出　　处：《中国超声医学杂志》2006年第8期598-600,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨室间隔完整的肺动脉闭锁的胎儿期超声诊断声像特征、检测技巧及其鉴别诊断,提高此类畸形的产前检出率。方法对33200例胎儿均采取胎儿心脏四腔心切面加胎儿头侧偏转法获得四腔心切面及左右心室流出道及主、肺动脉长轴切面快速筛查胎儿心脏畸形,对疑有胎儿心脏畸形者则更行详细的胎儿彩色多普勒超声心脏检查。分析8例产前及产后诊断的室间隔完整的肺动脉闭锁的声像特征和病理特征。结果产前共诊断室间隔完整的肺动脉闭锁8例,其主要声像特征是8例均有肺动脉内径细小,彩色多普勒于三血管气管平面显示7例动脉导管内血流反向,7例右室右房扩大,6例右室壁厚,7例中重度三尖瓣反流,1例三尖瓣下移畸形,1例三尖瓣狭窄并右室小。结论肺动脉内径细小、不同程度的右房右室扩大、三尖瓣畸形、右室发育不良、动脉导管内血流反向是肺动脉闭锁的主要声像特征,三血管气管平面是产前超声诊断室间隔完整的肺动脉闭锁的关键切面,需注意与主动脉闭锁、永存动脉干进行鉴别。Objective To analyze the key markers for prenatal ultrasonographic diagnosis of pulmonary atresia with intact ventricular septum （PAIVS） . Methods Thirty-three thousand and two hundred low risk or high risk people were referred to routine fetal echocardiography including four-chamber view and outflow tracts and/or long axis view of the great arteries. When fetal congenital heart defects or other organ anomalies were suspected, the fetal heart were examined in detail on color Doppler fetal echocardiography. We reviewed the echocardiograms and the pathology in 8 cases with PAIVS. Results Eight cases with PAIVS were diagnosed on prenatal ultrasonography. All eight cases presented small pulmonary artery. Seven PAIVS cases demonstrated reversed flow through the ductus arteriosus on three vessel tracheal view on CDFI. In 7 of these cases, there were dilated right atrium and right ventricle indicating severe tricuspid regurgitation caused by ＂tricuspid valvular dysplasia＂. One of them had a severely hypoplastic small tricuspid valve and another one was associated with Ebstein＇s malformation with severe tricuspid valvular regurgitation. There was hypertrophic right ventricle in 6 cases with PAIVS. Conclusions Small pulmonary artery, reversed flow through the ductus arteriosus in three vessel tracheal view on CDFI, right atrial and right ventricular dilatation associated with tricuspid valvular dysplasia conjugated with severe tricuspid regurgitation or Ebstein＇s malformation of severely hypoplastic small tricuspid valve were the main echocardiographic features of PAIVS. Three vessel tracheal view is a key view of prenatal diagnosis of pulmonary atresia.

关 键 词：肺动脉闭锁 大血管 胎儿 超声 产前诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]