超声心动图诊断胎儿单心室分型与合并畸形的价值  

Diagnostic value of fetal single ventricle types and accompanied malformations by echocardiography

作　　者：李军[1] 苏海砾[1] 朱霆[1] 郑敏娟[1] 徐鹏[1] 孙益前[1] 王峥[1] 张建芳[2] 马向东[3] 张俊茹[3] 

机构地区：[1]第四军医大学西京医院超声诊断科陕西省胎儿先天性心脏病超声诊断中心,西安710032 [2]第四军医大学西京医院产科实验室,西安710032 [3]第四军医大学西京医院妇产科,西安710032

出　　处：《中华超声影像学杂志》2012年第8期649-652,共4页Chinese Journal of Ultrasonography

基　　金：陕西省社会发展攻关项目（2010K506-03）;西京医院自主创新基金（XJZT09M03）;陕西省科技统筹创新工程计划关键技术项目（2012KTCL03-09）

摘　　要：目的探讨单心室在胎儿期的常见类型、合并畸形和超声心动图检查中应注意的问题。方法选择我院胎儿超声心动图检查明确诊断的先天性心脏病345例中单心室73例，其中双胎3例。采用全面、系统的多切面胎儿超声心动图连续扫查法，并进行鉴别诊断。结果73例单心室中单纯性3例，合并单心房44例，合并单心房并永存动脉干18例、肺动脉闭锁2例，合并单心房并肺动脉口狭窄20例、部分型房室隔缺损4例、主动脉或瓣膜发育不良3例。单心室分型：A型24．7％，B型13．7％，c型46．6％，D型15．0％；主动脉右转位68．2％；共同流人型单心室45．2％，单流人型42．5％，双流人型12．3％。终止妊娠42例，病理证实11例，失访31例。结论胎儿单心室病例中合并畸形发生率较高；分型中以混合型c型及主动脉右转位最多见；超声心动图检查中应注意心腔内粗大乳头肌和异常肌束与室间隔的鉴别，避免漏诊。Objective To improve detection rate and diagnostic accuracy of single ventricle（SV） in obstetric fetal echocardiography, to investigate the common types and complicated malformations of SV in the fetus,and to summarize the differential announcements in diagnosing fetal SV. Methods In 345 fetal hearts which were diagnosed as congenital heart disease by fetal echocardiography in our hospital,73 cases diagnosed as SV,including 3 cases appeared as ones of twins,were included in this study. Systemic scanning and multiple-views fetal echocardiography were used to examine these enrolled fetuses. Results In all 73 SV cases,3 cases were diagnosed as simple SV, the others were diagnosed as SV accompanied with other abnormalities,among them 44 cases accompanied with single atrium, 18 cases with single atrium and persistent truncus arteriosus,2 cases with pulmonary atresia,20 cases with pulmonary artery stenosis, 4 cases with partial atrioventricular septal defect, 3 cases with aorta dysplasia or aortic valve dysplasia. SV types were classified as 24.7% in type A, 13.7% in type 13, 46.6%//00 in type C and 15.0% in type 13 respectively. 68.2 % of the cases were diagnosed with aortic D-transposition, and 45.2 % with common inlet, 42.5% with single inlet and 12.3% with double inlet respectively. 42 SV cases were executed termination of pregnancy which 11 cases were confirmed by pathology and the other 31 cases were out of following-up. Conclusions Most cases of fetal SV were accompanied other abnormalities and simple SV was rare. Type C in which ventricular structure was combined with left and right ventricle was the most common type. To avoid the false diagnosis, much attention must be paid to distinguish big papillary muscle and abnormal muscle bundle from interventricular septum during ultrasonic examination.

关 键 词：超声心动描记术 胎儿 心脏缺损 先天性 单心室 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]