胎儿超声心动图在诊断主-肺动脉间隔缺损中的应用  

The use of fetal echocardiography in the prenatal diagnosis of aortopulmonary septal defect

作　　者：潘琦[1] 邓学东[1] 王珍琦[1] 徐秋琴[2] 马建芳[1] 张俊[1] Deng Xuedong;Wang Zhenqi;Xu Qiuqin;Ma Jianfang;Zhang Jun(Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215002, China;Department of Cardiology,Children′s Hospital of Soochow University, Suzhou 215000, China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院超声中心,215002 [2]苏州大学附属儿童医院心超室,215000

出　　处：《中华医学超声杂志（电子版）》2018年第12期925-930,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨主-肺动脉间隔缺损(APSD)的胎儿超声心动图特征。方法回顾2008年1月至2017年12月在南京医科大学附属苏州医院苏州市立医院超声中心产前诊断APSD的4例胎儿超声心动图图像,总结胎儿APSD超声心动图特征及产前诊断APSD的临床意义。结果 4例胎儿APSD最直接的表现是升主动脉和主肺动脉之间的间隔出现回声连续中断,产前超声诊断APSD最关键的切面是三血管观、三血管气管观和大动脉短轴观,彩色多普勒血流成像(CDFI)于缺损处可探及双向、右向左或左向右的低速分流信号。超声提示可能存在APSD的间接征象主要是升主动脉内径增宽。4例胎儿APSD均合并其他心内畸形,其中1例为Berry综合征,1例还合并心外畸形。结论 APSD有特征性胎儿超声心动图表现。发现远端型APSD时要注意是否为Berry综合征,Berry综合征合并遗传学异常风险较高。产前诊断APSD可行,且对患儿出生后及时接受手术治疗和改善预后意义重大。Objective To investigate the echocardiographic features and clinical significance of prenatal diagnosis of aortopulmonary septal defect (APSD). Methods Images of 4 cases of APSD diagnosed by fetal echocardiography during January 2008 to December 2017 in the affiliated Suzhou hospital of Nanjing medical university were reviewed. Echocardiographic features and clinical significance of prenatal diagnosis of APSD were summarized. Results The key feature of prenatal diagnosis of APSD was the demonstration of a connection between the ascending aorta and main pulmonary artery. The defect could be best identified on the three-vessel view, three-vessel and trachea view and short axis view of great arteries. Flow across the defect could be bidirectional, left-to-right or right-to-left. Dilated ascending aorta may be seen as an indirect sign of APSD. All the 4 cases were associated with other cardiac anomalies, including 1 case of Berry syndrome. One case was associated with extracardiac abnormalities. Conclusions There are fetal echocardiographic features of APSD. Berry syndrome, which was commonly associated with genetic anomaly, should be suspected when distal type APSD was found. Prenatal diagnosis of APSD is feasible and essential as a surgical correction early after birth can improve the prognosis.

关 键 词：超声检查 产前 主-肺动脉间隔缺损 先天性心脏病 

分 类 号：R540.45[医药卫生—心血管疾病] R714.5[医药卫生—内科学]