S,D,L型解剖矫正型大动脉异位的产前超声心动图特征  

Prenatal echocardiographic features of anatomically corrected malposition of the great arteries{S,D,L}

作　　者：李文秀[1] 方海燕[2] 耿斌[1] 杨爽[1] 吴江[1] LI Wenxiu;FANG Haiyan;GENG Bin;YANG Shuang;WU Jiang(Pediatric Cardiovascular Center,Beijing Anzhen Hospital Affiliated to the Capital Medical University,Beijing 100029,China;Ultrasound Department,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China)

机构地区：[1]首都医科大学附属北京安贞医院儿童心血管病中心,北京100029 [2]暨南大学附属第一医院超声医学科,广州510630

出　　处：《中国循证儿科杂志》2020年第5期365-369,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的探讨S,D,L型解剖矫正型大动脉异位(ACMGA)的产前超声心动图特征,提高本病产前超声诊断准确性。方法回顾性分析2016年11月至2020年8月经首都医科大学附属北京安贞医院儿童心血管病中心产前超声心动图诊断的S,D,L型ACMGA胎儿的超声心动图特点,总结其超声心动图图像及鉴别要点。结果共诊断5例胎儿,孕妇年龄26~35(29.4±3.6)岁,孕周23~28(24.2±2.2)周,4例引产(1例尸检),1例出生后经超声心动图、心脏CT及外科手术(肺动脉环缩术)证实。超声心动图特征:①心房正位,心室右襻,房室连接一致;②大动脉平行发自相对应的心室;③主动脉与肺动脉空间位置异常,包绕关系消失,主动脉位于肺动脉左前方;④2条大动脉间可见圆锥肌(主动脉下和/或肺动脉下);⑤主动脉瓣与二尖瓣之间可见主动脉下圆锥肌;⑥肺动脉瓣与三尖瓣之间多无肺动脉下圆锥肌;⑦左室流出道较长,形态似"天鹅颈";⑧常合并室间隔缺损、双侧心耳并置、永存左上腔静脉等心内畸形。结论产前超声心动图扫查时要严格遵循Van Praagh的节段分析原则,明确每个心脏节段的解剖状况;S,D,L型ACMGA需要与右室双出口进行鉴别诊断。Objective To analyze the prenatal echocardiographic features of anatomically corrected malposition of the great arteries(ACMGA){S,D,L}in order to improve the prenatal diagnosis accuracy.Methods Fetal echocardiographic features were retrospectively analyzed with prenatal diagnosis of ACMGA{S,D,L}at Beijing Anzhen Hospital between November 2016 and August 2020,and the fetal echocardiography characteristics of ACMGA{S,D,L}and the key points of its identification were summarized.Results There were 5 fetuses with ACMGA.The age of pregnant women was 26 to 35(29.4±3.6)years old,and the pregnancy period was 23 to 28(24.2±2.2)weeks.Four cases had induced labor including 1 case of diagnosis confirmation by postmortem examination.One case was confirmed by echocardiography,cardiac CT and surgery(pulmonary artery banding)after birth.Echocardiographic features included:a.The viscera and atria were in situs solitus,the type of ventricular loop was d⁃loop and atrioventricular connections was normal.b.The aorta originated above the left ventricle,the pulmonary artery originated above the anatomically right ventricle and their proximal segments were parallel to each other.c.The spatial relationship between the arota and pulmonary artery was abnormal and the aorta was to the left of the pulmonary artery.d.The muscular conus(subaortic and/or subpulmonary)was showed between the two arteries.e.A muscular subaortic conus separated the aortic and mitral valves.f.There was always no muscular subpulmonary conus between pulmonary valve and tricuspid valve.g.The left ventricular outflow tract was longer and the shape was like"swan neck".h.This malformation was usually associated with ventricular septal defect(VSD),bilateral atrial appendage juxtaposition,persistent left superior venacava(PLSVC),and other intracardiac malformations.Conclusion The Van Praagh segmental analysis principle should be strictly followed during the scan to determine the anatomical status of each cardiac segment.The differential diagnosis of ACMGA{S,D,L}is mainly

关 键 词：解剖矫正型大动脉异位 超声心动图 产前 右室双出口 孤立性心室反位 

分 类 号：R714.5[医药卫生—妇产科学] R540.45[医药卫生—临床医学]