单纯性完全性肺静脉异位引流的产前超声诊断  

Prenatal diagnosis of isolated total anomalous pulmonary venous connection by echocardiography

作　　者：杨荣萍 贺山鹰 冯雪涛[3] YANG Rongping;HE Shanying;FENG Xuetao(Department of Ultrasound,Longchang People′s Hospital of Neijiang City,Longchang,Sichuan 642150,China;Department of Ultrasound,Xi′an Angel Maternity Hospital,Xi′an,ShaanXi 710075,China;Department of Cardiac Function,the First People′s Hospital of Chengdu,Sichuan 610000,China)

机构地区：[1]四川省内江市隆昌市人民医院超声科,642150 [2]西安安琪儿妇产医院超声科,710075 [3]成都市第一人民医院心功能科,610000

出　　处：《重庆医学》2019年第17期2979-2982,共4页Chongqing medicine

摘　　要：目的探讨产前超声心动图对单纯性完全性肺静脉异位引流(ITAPVC)的诊断价值及漏诊原因。方法选取2009年1月至2017年6月隆昌市人民医院产前超声诊断并经产后超声心动图(或引产后尸检)证实为ITAPVC的胎儿18例,回顾性分析其产前超声筛查资料,总结二维超声及彩色多普勒血流成像(CDFI)特征,并随访临床结果。结果18例ITAPVC中,心上型13例,心内型2例,心下型3例。13例不伴肺静脉回流梗阻,其中11例经产前超声筛出(7例于中期筛查时检出,4例于晚期筛查时检出),另2例产前漏诊,产后超声确诊;11例均经优生咨询,选择继续妊娠,于产后及时手术干预,均疗效满意。5例伴肺静脉回流梗阻,其中4例于产前筛查检出[3例梗阻均位于垂直静脉(VV)汇入左无名静脉处,1例位于VV穿膈肌处],选择终止妊娠,并经尸解确诊;另1例产前漏诊,继续妊娠,产后即出现难以控制的发绀、呼吸困难,并于出生后2 h即死亡,经尸检证实为心下型,伴VV穿膈肌处狭窄。结论肺静脉入口的观察是ITAPVC产前诊断及减少漏诊的关键,肺静脉回流梗阻有无的判断是该病诊断的重要内容。Objective To explore the value of prenatal echocardiography in the diagnosis of isolated total anomalous pulmonary venous connection(ITAPVC)and the causes of missed diagnosis.Methods 18 fetuses with ITAPVC diagnosed by prenatal ultrasound and confirmed by postpartum echocardiography(or postpartum autopsy)from January 2009 to June 2017 in Longchang People′s Hospital were retrospectively analyzed.The characteristics of two-dimensional ultrasound and color doppler flow imaging(CDFI)features were summarized and the clinical results were followed up.Results There were a total of 18 cases of ITAPVC,including 13 cases of supracardiac type,2 cases of intracardiac type and 3 case of infracardiac type.13 cases were not accompanied by pulmonary venous reflux obstruction,of which 11 cases were screened out by prenatal echocardiography(7 cases were detected in mid-term screening,4 cases were detected in late screening),2 case were missed diagnosis and confirmed by post-natal echocardiography diagnosis.All the 11 cases chose to continue pregnancy after eugenics consultation.After timely surgical intervention,the curative effect was satisfactory.5 cases with pulmonary venous return obstruction were diagnosed,of which 4 cases were found by prenatal screening[3 cases were located at the influx of vertical vein(VV)into the left anonymous vein,1 case was located at the diaphragm of VV],and pregnancy was terminated and confirmed by autopsy.Another case was missed diagnosis before delivery and continued pregnancy,and had uncontrollable cyanosis and dyspnea after delivery,and died 2 hours later.Autopsy confirmed subcardiac type with VV stricture in the diaphragm.Conclusion It is the key to prenatal diagnosis and reduce missed diagnosis of ITAPVC for observation of pulmonary vein portal.The determination of pulmonary venous return obstruction is an important part of its diagnosis.

关 键 词：完全性肺静脉异位引流 单纯性 超声心动图描记术 产前诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]