胎儿超声心动图在诊断孤立性冠状动脉瘘中的价值  

The value of fetal echocardiography in the diagnosis of isolated coronary artery fistula

作　　者：黄珊珊[1] 郭勇[2] 张烨[2] 孙琳[2] 谷孝艳[2] 赵映[2] 李振洲[1] 何怡华[2] Huang Shanshan;Guo Yong;Zhang Ye;Sun Lin;Gu Xiaoyan;Zhao Ying;Li Zhenzhou;He Yihua(Department of Ultrasound, the First Affiliated Hospital of Shenzhen University, the Second People′s Hospital of Shenzhen, Shenzhen 518035, China;Department 2 of Echocardiography, Beijing Anzhen Hospital Capital Medical University, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing 100029, China)

机构地区：[1]深圳大学第一附属医院深圳市第二人民医院超声科,518035 [2]首都医科大学附属北京安贞医院超声心动科二部胎儿心脏病母胎医学研究北京市重点实验室,100029

出　　处：《中华超声影像学杂志》2019年第10期864-868,共5页Chinese Journal of Ultrasonography

基　　金：国家重点研发计划(十三五计划)(2018YFC1002300);胎儿心脏病母胎医学研究北京重点实验室(BZ0308);心血管疾病精准医学北京实验室(116211);深圳医疗卫生三名工程(SZSM201612027).

摘　　要：目的探讨胎儿孤立性冠状动脉瘘(CAF)的超声特征.方法回顾分析2011年12月至2018年3月产前诊断为孤立性CAF的13例胎儿超声心动图资料及随访结果,根据产前有无主动脉弓舒张期血流逆灌分为逆灌组与无逆灌组,测量各组胎儿受累冠状动脉内径及主动脉瓣环内径,计算二者比值(CA/AO),对冠状动脉内径、 CA/AO比值与是否出现逆灌进行分析;同时将母胎医学会诊中心多学科会诊后建议引产,以及活产婴儿生后复查超声心动图出现心腔扩大、肺动脉高压均定义为产后不良事件,并依据是否出现产后不良事件进行分组,分析主动脉弓舒张期血流逆灌与产后不良事件发生率的相关性.结果①13例胎儿CAF的超声心动图特点为受累冠状动脉不同程度扩张;心腔或大血管内异常血流信号,瘘入心房时瘘管内为双期连续频谱,瘘入心室时为舒张期为主双期双向连续频谱.7例胎儿主动脉弓舒张期血流逆灌.②逆灌组CA/AO比值明显大于无逆灌组,差异有统计学意义[(0 .63 ± 0 .24) mm 对(0 .39 ± 0 .09) mm ,P = 0 .047];逆灌组冠状动脉内径与无逆灌组差异无统计学意义[(3 .00 ± 1 .25) mm对(2 .03 ± 0 .62) mm ,P =0 .115].③逆灌组胎儿发生产后不良事件的概率高于无逆灌组,差异有统计学意义[80%对20%,χ2 =4 .80 ,P =0 .028].结论胎儿孤立性CAF超声心动图有特征性表现, CA/AO比值、主动脉弓舒张期血流逆灌是两个重要参考指标.Objective To investigate the ultrasonic features of fetal isolated coronary artery fistula (CAF). Methods A total of 13 cases of fetal isolated CAF from December 2011 to March 2018 were retrospectively analyzed. Data of echocardiography and follow-up were collected.All cases were divided into retrograde group and no retrograde group based on the presence of diastolic retrograde flow in aortic arch. The inner diameters of affected coronary arteries (CA) and aortic annulus (AO) were measured, and the CA to AO ratios (CA/AO) were then calculated.Correlations between CA, CA/AO and the presence of retrograde flow were analyzed. Adverse birth outcomes including abortion, enlarged cardiac cavity, pulmonary hypertension were recorded at follow-up. Correlation between diastolic retrograde flow in aortic arch and the rate of adverse birth outcomes was analyzed. Results ①Thirteen cases of fetal CAF were characterized by the varying degrees of dilation of affected coronary arteries. Thirteen cases were presented with abnormal blood flow in the large arteries or cardiac cavities: biphasic continuous flow pattern in atrio-coronary fistula and biphasic bidirectional continuous flow pattern with a diastolic dominant flow in coronary artery to ventricle fistula. Seven cases were presented with retrograde holodiastolic flow in aortic arch.②The CA/AO ratios of retrograde group was higher than in no retrograde group [(0.63±0.24)mm vs (0.39±0.09)mm, P=0.047], there was no significant difference of CA between the two groups [(3.00±1.25)mm vs (2.03±0.62)mm, P=0.115].③The rate of adverse birth outcomes in retrograde group was higher than in no retrograde group (80% vs 20%,χ2=4.80, P=0.028). Conclusions Fetal isolated CAF has distinct ultrasonic features. Abnormal CA/AO ratio and diastolic retrograde flow in aortic arch are significant ultrasonic features and has prognostic values.

关 键 词：超声心动描记术 胎儿 冠状动脉瘘 主动脉弓血流逆灌 

分 类 号：R54[医药卫生—心血管疾病] R714[医药卫生—内科学]