先天性肺动脉闭锁的产前超声诊断  

Prenatal ultrasonographic diagnosis of congenital pulmonary artesia

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,518028

出　　处：《中华超声影像学杂志》2007年第1期51-54,共4页Chinese Journal of Ultrasonography

摘　　要：目的探讨先天性肺动脉闭锁的胎儿期超声图像特征、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行更详细的胎儿彩色多普勒超声心脏检查。分析22例产前及产后诊断的肺动脉闭锁的声像特征和病理特征。结果产前共诊断肺动脉闭锁20例，误诊为永存动脉干2例，根据产前和产后声像图及病理资料将其分为3型：Ⅰ型，肺动脉闭锁不伴室间隔及不同程度的右室发育不良和三尖瓣异常；Ⅱ型，法洛四联症并肺动脉闭锁，即肺动脉闭锁伴室间隔缺损和主动脉骑跨；Ⅲ型，肺动脉闭锁合并其他大血管异常。主要声像图表现为：肺动脉内径细小、绝大部分病例于三血管-气管平面彩色多普勒显示动脉导管内血流反向。结论肺动脉内径细小，主动脉相对粗大，三血管-气管平面显示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-气管平面是诊断先天性肺动脉闭锁的关键切面，需注意与永存动脉干和主动脉闭锁进行鉴别。Objective To analyze the key markers for prenatal ultrasonographic diagnosis of congenital pulmonary artesia. Methods Thirty-three thousands and two hundreds low risk or high risk people were referred for routine fetal echocardiography including four-chamber view and outflow tracts and/or long view of the great arteries. When suspected fetal congenital heart defects or other organs anomalies, the fetal heart were more detailed by color Doppler fetal echocardiography. Echocardiograms were reviewed and compared with pathologies. Results Twenty cases with pulmonary artesia were diagnosed by prenatal ultrasonography, two cases were antenatal misdiagnosed for truncus arteriosus. Pulmonary artesia could be classified into three types by fetal echocardiograms and pathologies. Type Ⅰ： pulmonary atresia with intact ventricular septum often presenting varying degrees of hypoplastic right ventricle and tricuspid valve anomalies; type Ⅱ： tetralogy of Fallot with pulmonary atresia, i. e pulmonary atresia with septal defect and aorta overrideing;typeⅢ..others. All three types present very small pulmonary diameters and most cases with reversed flow through the ductus arteriosus on three vessels trachea view by color Doppler flow imaging. Conclusions Very small pulmonary diameters and reversed flow through the ductus arteriosus on three vessels trachea view by color Doppler flow imaging are the main prenatal sonography markers of pulmonary atresia. Three vessels trachea view is a key view of antenatal diagnose pulmonary atresia. It needed to be differenated from truncus arteriosus and aorta atresia.

关 键 词：超声检查 产前 肺动脉瓣闭锁 

分 类 号：R686[医药卫生—骨科学]