胎儿永存动脉干的超声诊断及预后评估  

Clinical diagnosis value of echocardiography and prognosis evaluation to fetus with persistent truncus arteriosus

作　　者：陆丽花[1] 王峥[2] 李军[2] 田晓先[1] 徐鹏[2] 朱霆[2] 庞坤[2] 王云[2] 英司奇 

机构地区：[1]广西壮族自治区妇幼保健院超声科,南宁530003 [2]第四军医大学西京医院超声医学科 陕西省胎儿先天性心脏病超声诊断中心 [3]重庆医科大学

出　　处：《中华超声影像学杂志》2017年第6期494-499,共6页Chinese Journal of Ultrasonography

基　　金：陕西省科技统筹创新工程计划项目（2012KTCL03-09）;陕西省出生缺陷防治科研课题（Sxws jswzf cght 2016-012）;陕西省社发科技攻关项目（2016SF-098）

摘　　要：目的探讨胎儿永存动脉干（PTA）的产前超声诊断、病理分型、鉴别诊断及伴发畸形。方法选取经胎儿超声心动图检查明确诊断的1392例胎儿心血管畸形中24例PTA，对其超声诊断、病理及随访结果进行分析。根据VanPraagh分类法进行分型，将Ⅳ型PTA归人肺动脉闭锁，未纳入本研究。结果24例PTA中A1型1（）例，A2型3例，A3型9例，A4型2例。合并心内畸形及变异9例，合并心内及心外畸形1例。出生2例（1例A1型手术，双胎1例出生后多器官衰竭死亡）；终止妊娠14例（7例再次妊娠5例出生，仅1例存在房间隔缺损；2例中孕待随访），病理证实7例；失访8例。结论胎儿PTA类型以A1型及A3型较多见；合并心内畸形与类型有一定关系；胎儿期联合应用多种超声成像技术能早期准确诊断PTA，判断类型和检出合并畸形，对孕期咨询、评估、抉择及出生后救治具有重要意义。Objective To evaluate prenatal diagnosis value of echocardiography in pathological types, differential diagnosis and accompanied malformations of fetal persistent truncus arteriosus（PTA）. Methods Twenty-four cases of PTA selected from 1 392 cases were analysed, who were definitely diagnosed to be suffered from cardiovascular malformation by fetal echocardiography. The ultrasound findings, pathological results and followed up were analysed. According to Van Praagh classification, the type IV PTA was excluded in this study which was classified into pulmonary artery atresia. Results The total PTA were 24 cases, in which 10 cases of A1 type,3 cases of A2 type, 9 cases of A3 type, and 2 cases of A4 type. Nine cases of PTA accompanied other cardiac anomalies, and 1 case of PTA accompanied both cardiac anomalies and extracardial malformations. Two PTA cases were born, one was A1 type underwent surgical intervention, and the other was died due to multiple organ-failure. Fourteen PTA cases were termination and 7 cases were confirmed by pathology. Seven women pregnant again, of which 5 cases were born while only one was diagnosed atrial septal defect after birth, 2 pregnant women were still during follow-up. Eight PTA cases follow-up were lost. Conclusions A1 type and A3 type of PTA have high incidence in fetus. Accompanied cardiac anomalies is certainly related to different types. Combination of multiple ultrosund techniques can diagnose PTA prenatally, make accurate classification and detect accompanying malformations, which is of great significance to offer proper pregnancy counselling and postpartum treatment.

关 键 词：超声心动描记术 胎儿 永存动脉干 

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]