胎儿心脏超声对室间隔缺损的诊断价值  

Value of fetal echocardiography on prenatal diagnosis of ventricular septal defect

作　　者：姚英[1] 严英榴[1] 张蕴[1] 赵蔚[1] 黄晓微[1] 孔凡斌[1] 任芸芸[1] 储晨[2] 张聪聪[2] 桂永浩[2] 

机构地区：[1]复旦大学附属妇产科医院超声科,上海200011 [2]上海复旦大学附属儿科医院心血管中心

出　　处：《中华围产医学杂志》2013年第4期211-215,共5页Chinese Journal of Perinatal Medicine

基　　金：国家高技术研究发展计划项目（2007AA022442）

摘　　要：目的探讨产前胎儿心脏超声检查对室间隔缺损（ventricular septal defect，VSD）的诊断价值及局限性。方法2009年1月1日至2010月10月31日，在复旦大学附属妇产科医院进行系统产前检查的孕妇于妊娠20～24周进行胎儿心脏超声检查，产后48h新生儿接受心脏超声检查；引产终止妊娠者行胎儿尸体解剖以明确心脏畸形的诊断，共纳入孕妇4392例（1例双胎妊娠，胎儿4393例）。计算产前超声对于VSD的检出率及漏诊率。结果（1）复杂性VSD检出情况：产前胎儿心脏超声检查共检出23例复杂性VSD，其中1例合并部分性心内膜垫缺损，但产后新生儿心脏超声未见异常，另22例均引产终止妊娠，引产胎儿尸体解剖证实产前诊断。（2）单纯性VSD检出情况：产前胎儿心脏超声检出16例单纯性VSD，其中15例产后新生儿心脏超声未见异常，另1例产后新生儿心脏超声证实为单纯性VSD。（3）检出率：产前胎儿心脏超声检查中未检出VSD的4354例胎儿中，产后新生儿心脏超声检出54例VSD，均为单纯性。产前检出产后证实的及产后诊断的VSD共77例，发生率为1．8％（77／4393），单纯性VSD发生率为1．3％（55／4393），复杂性VSD发生率为0．5％（22／4393）。产前胎儿心脏超声检查对于复杂性VSD的检出率为100．0％（22／22），漏诊率为0．0％（o／22），误诊率为0．2‰（1／4371）。产前单纯性VSD的检出率为1．8％（1／5s），漏诊率较高（98．2％，54／55），误诊率为3．5X。（15／4338）。结论产前胎儿心脏超声检查对于合并有其他心脏结构异常的复杂性VSD的检出率及准确率高；而对于单纯性VSD，有较高的漏诊率及误诊率。Objective To investigate the diagnostic value and limitations of prenatal echocardiography on fetal ventrieular septal defect （VSD）. Methods Fetal echocardiography was performed on 4392 pregnant women （including one twin pregnancy） during their 20 to 24 weeks of gestation who accepted routine prenatal care in Obstetrics and Gynecology Hospital of Fudan University from January 1, 2009 to October 31, 2010. Neonatal echocardiography was performed within 48 hours after birth~ and fetal autopsy was done for mid-trimester terminated cases to confirm the diagnosis. Detection rate and missed diagnosis rate of prenatal echocardiography on MSD were calculated. Results （1） Complicated VSD （associated with other cardiac defects）： Twenty-three cases of complicated VSD were detected prenatally, among which 22 cases were terminated at mid- trimester and another one was suspected as VSD complicated with partial endoeardial cushion defect, while it was finally diagnosed as normal after birth. （2） Isolated VSD： Sixteen prenatally suspected VSD were confirmed after birth as 15 normal cases and one case of isolated VSD. （3）Detection rate of prenatal echoeardiography： Among the rest 4354 cases without VSD in prenatal eehocardiography, there were 54 eases of isolated VSD by neonatal echocardiography. A total of 77 cases of VSD were confirmed by prenatal and postnatal two-dimension echocardiography or autopsy. The incidence of VSD was 1.8% （77/4393）, isolated VSD was 1.3% （55/4393）, and complicated VSD was 0.5% （22/4393）. Prenatal detection rate of complicated VSD was 100.0% （22/22） ; missed diagnosis rate and misdiagnosis rate was 0.0%（0/22） and 0.2‰ （1/4371） respectively. Prenatal detection rate of isolated VSD was 1.8% （1/55）, missed diagnosis rate and misdiagnosis rate was 98.2% （54/55） and 3.5‰ （15/4338） respectively. Conclusions Prenatal detection rate of VSD by echocardiography on fetus with complicated VSD is high, while prenatal detection rate of fetal isola

关 键 词：室间隔缺损 超声检查 产前 超声心动描记术 多普勒 彩色 

分 类 号：R44[医药卫生—诊断学] R714[医药卫生—临床医学]