超声心动图检测胎儿右优势心及其临床意义  

Prenatal Echocardiography on the Detection of Fetal Right Dominant Heart

作　　者：吕国荣[1] 林惠通[1] 王振华[1] 胡诗音[1] 李伯义[1] 徐晚虹[1] 何韶铮[1] 李丽雅[1] 

机构地区：[1]福建医科大学附属第二医院超声科,福建省泉州市362000

出　　处：《中国超声医学杂志》2010年第11期1024-1027,共4页Chinese Journal of Ultrasound in Medicine

基　　金：福建省自然科学基金(No.2007J0076)

摘　　要：目的评价超声心动图检测胎儿右优势心(RDH)的临床意义,描述各类RDH胎儿的超声心动图特点。方法回顾性地总结和分析40例RDH胎儿的声像图特点。RDH胎儿的诊断标准:产前超声心动图检测胎儿右、左心房和心室的内径比及肺动脉与主动脉直径比>1.5;产前超声心动图排除胎儿先天性心脏病(CHD)(尤其CoA)和心外畸形。结果 (1)40例RDH胎儿。产后超声心动图或临床随访证实15例(37.5%)为正常胎儿,9例(22.5%)为RDH伴IUGR和动脉导管瘤,16例(40%)为RDH伴发CHD;RDH伴发的CHD包括主动脉缩窄6例,肺静脉异位引流3例,静脉窦型房间隔缺损、室间隔缺损、永存左上腔静脉伴冠状窦扩张各2例、主动脉弓离断1例。(2)RDH伴发CHD的胎儿其RDH发生的时间要早于RDH伴发IUGR、动脉导管瘤或正常RDH胎儿(P<0.05或0.001)。RDH伴发CHD胎儿其三尖瓣反流发生率、RA/LA、RV/LV、PA/AO明显高于RDH伴IUGR、动脉导管瘤或正常RDH胎儿(P<0.05或0.001)。(3)RDH伴CHD胎儿随妊娠时间增加,其RDH逐渐加重(P<0.05或0.005)。结论 (1)RDH胎儿产后常伴发CHD,尤其CoA,产后应加强随访观察;(2)RDH伴CHD胎儿有一定的超声心动图特点,可以与RDH伴IUGR、动脉导管瘤及正常RDH胎儿相鉴别。Objective To evaluate the clinical role of fetal echocardiography （FEGG）on the detection of fetus with right dominant heart （RDH）, and describe the eehocardiographie characteristics of various types of RDH. Methods 40 fetuses who were prenatally diagnosed as RDH by fetal echocardiography over the last 6 years in our hospital were retrospectively investigated for their sonographic features. RDH was defined when the ratio of the right-toleft atrial and ventrieular maximal width on four chamber view was greater than 1.5 and the ratio of the diameter of the pulmonary artery-to aorta was not less than 1.5. Fetuses with congenital heart disease（CHD）, especially the coarcta tion of the aorta（CoA） ,noncardiac malformations were excluded by prenatal FECG. Results （1）40 fetuses were diagnosed as RDH by eehocardiography. Postnatal echoeardiography or clinical follow-up confirmed that 15 of them （37.5 % ）were normal. 9 （22.5 % ）were with RDH complicating IUGR and duetal aneurysm. 16 （40%）were with RDH complicating CHD. The fetuses with RDH complicating CHD included 6 cases of CoA,3 of anomalous pulmonary venous drainage,2 of sinus venous type of interatrial septal defect,2 of ventricular septal defect,2 of persistent left superior cava associated with dilated coronaty sinus,and 1 of intertuption of aortic arch. （2）Right dominant heart appeared more earlier in the fetuses with RDH complicating CHD than in the fetuses with RDH complicating IUGR and ductal aneurysm or the normal RDH fetuses （P〈0.05 and 0. 001, respectively）. The likelihood of tricuspid regurgitation, RA/LA,RV/LV,PA/AO of fetuses with RDH complicating CHD were significantly higher than those of fetuses with RDH complicating IUGR and ductal aneurysm or the normal RDH fetuses （P〈0.05 or 0. 001）. （3）The severity of right heart dominance in the fetus with RDH complicating CHD increased with gestational age （P%0.05 or 0. 005）. Conclusions （1）CHD,especially CoA,was often seen after birth in the fetuses with R

关 键 词：右优势心 胎儿超声心动图 先天性心脏病 

分 类 号：R540.45[医药卫生—心血管疾病] R714.5[医药卫生—内科学]