法洛四联症的产前超声心动图诊断价值及误诊分析  

Diagnostic value and misdiagnosis analysis of tetralogy of Fallot by prenatal echocardiography

作　　者：张玉奇[1] 武育蓉 陈树宝[1] 张志芳[1] 王珊珊 陈丽君[1] 钟舒文 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心内科,200127

出　　处：《中华实用儿科临床杂志》2013年第13期973-976,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：上海市科委医学引导类项目（10411965300）;上海市教委科研创新项目重点项目（13ZZ081）

摘　　要：目的 评价超声心动图对法洛四联症（TOF）的产前诊断价值，分析超声心动图误诊的原因，以提高超声心动图对胎儿TOF诊断的正确率。方法 回顾性分析36例经胎儿MRI或产后超声心动图诊断为TOF 的患儿的产前超声资料。结果 36例胎儿超声心动图诊断正确31例，占86.1% ；误诊4例，占11.1% ；漏诊1 例，占2.8% 。其中2例超声心动图检查误诊为VSD，2例误诊为右心室双出口；1例孕20周时漏诊，诊断为正常胎儿，在孕36周复诊时发现对位不良型VSD、主动脉骑跨、肺动脉狭窄、右心室肥厚而诊断为TOF。产前诊断为TOF的31例胎儿均显示对位不良型VSD、主动脉骑跨、肺动脉狭窄，但仅6例有右心室肥厚。TOF最常见的合并畸形为三尖瓣返流13例（36.1%）、主动脉瓣返流6例（16.7%）、肺动脉瓣缺如4例（11.1%）、右位主动脉弓4例（11.1%）、左侧上腔静脉残存3例（8.3%）、完全性房室间隔缺损1例（2.8%）等。结论 联合应用四腔心切面、心室流出道切面及三血管切面，超声心动图可较准确地诊断胎儿TOF。Objective To evaluate the diagnostic value of prenatal echocardiography in fetus with tetralogy of Fallot （TOF） , and to analyze the reason of misdiagnosed in order to improve the echocardiographic diagnosis. Methods A retrospective echocardiographie review of 36 fetuses with TOF confirmed by prenatal magnetic resonance imaging （MRI） or postnatal eehoeardiography. Results Among 36 cases of TOF fetuses, 31 cases （ 86.1% ） were diagnosed correctly by echocardiography, and in the remaining 5 cases,4 cases （ 11.1% ） were misdiaguosed [ 2 cases misdiag-nosed as ventricular septal defects （ VSD）, 2 cases misdiagnosed as double outlet of fight ventricles ], and 1 case （2. 8% ） was missed diagnoses at 20 weeks gestation and confirmed as TOF at 36 weeks gestation based on the echo-cardiographie findings of malalignment type VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertro-phy. Malalignment type VSD, overriding aorta,and pulmonary stenosis were observed in 31 cases with TOF diagnosed by prenatal echocardiography, right ventricnlar hypertrophy was observed only in 6 cases. The most common associated ano- malies were tricuspid regurgitation in 13 cases（36.1% ） ,aortic insufficient in 6 cases（ 16.7% ） ,absent pulmonary valve in 4 cases （ 11.1% ）, right-side aortic arch in 4 cases （ 11.1% ）, persistent left superior vena cava in 3 cases （ 8. 3% ）, and complete atrioventricnlar septal defect in 1 case（2.8% ）. Conclusions Combining visualization of TOF in four-chamber view,outflow tract view,and three vessels view,TOF can be accurately diagnosed by prenatal echocardiography.

关 键 词：超声心动图 胎儿 法洛四联症 

分 类 号：R714.5[医药卫生—妇产科学]