产前超声心动图冠状切面在胎儿先天性心血管畸形诊断中的应用价值  

Value of prenatal echocardiographic coronal view in diagnosis of fetal congenital cardiovascular malformation

作　　者：吴江[1] 耿斌[1] 苏俊武[1] 李文秀[1] 杨爽[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心北京市心肺血管疾病研究所,100029

出　　处：《中国医药》2017年第12期1774-1777,共4页China Medicine

摘　　要：目的探讨超声心动图冠状切面在胎儿先天性心血管畸形诊断中的应用价值。方法选取2014年1月至2017年7月于首都医科大学附属北京安贞医院小儿心脏中心产前超声心动图检出并经产后证实的先天性心血管畸形胎儿70例，包括不同类型先天性血管环51例、主肺动脉间隔缺损7例、单纯性完全性肺静脉异位引流12例，回顾分析其产前常规超声切面、血管气管切面及冠状切面对先天性心血管畸形的超声图像特征，总结冠状切面对提高胎儿不同类型畸形的诊断准确性的价值。结果①加用冠状切面后，镜面有位主动脉弓形成的血管环及右位主动脉弓伴迷走左锁骨下动脉之左锁骨下动脉的显示率均明显提高，对右位主动脉弓伴左位动脉导管与双主动脉弓的鉴别性提高，但对双主动脉弓诊断无明显差别；②冠状切面可清晰显示主肺动脉间隔缺损长度及与2组半月瓣间的距离；③冠状切面可显示异位引流的静脉弓走行，并通过叠加彩色多普勒显示是否存在梗阻。结论超声心动图冠状切面可提供辅助、甚至关键的诊断信息，对提高胎儿先天性心血管畸形诊断的准确性具有重要的临床价值。Objective To investigate the application value of echocardiographic coronal view in diagnosis of fetal congenital cardiovascular malformation. Methods Totally 70 fetuses with congenital cardiovascular malfor- mation, induding 51 cases of congenital vascular ring, 7 cases of aorto-pulmonary septal defect and 12 cases of isolated total anomalous pulmonary venous drainage screened by echocardiography before birth in Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University from January 2014 to July 2017 were retrospectively analyzed. Images of routine echocardiographic view, three vessels and trachea view and coronal view were analyzed to evaluate the diagnostic value of coronal view for different types of fetal anomalies. Results （~With combined use of coronal view, display rates of vascular ring formed by right aortic arch and the left subclavian artery in RAA accompanied by aberrant left subclavian artery were significantly increased; the discriminability between right aortic arch accompanied by left ductus arteriosus and double aortic arches was also improved; but the detectability of double aortic arches was almost the same compared with routine echocardiographic view. ②Images of coronal view could clearly show the length of aorto-pulmonary septal defect and the distance between 2 groups of semilunar valves. ③Imagine of coronal view could show the shape of anomalous venous arch; superimposed color Doppler could show the obstruction. Conclusion Echocardiographic coronal view can provide auxiliary and useful information for improving diagnostic accuracy of fetal congenital cardiovascular malformation.

关 键 词：先天性心血管畸形 血管环 胎儿超声心动图 冠状切面 

分 类 号：R541.1[医药卫生—心血管疾病]