肺动脉瓣缺如的产前超声心动图诊断价值分析  

Analysis of prenatal diagnostic value of echocardiography in absent pulmonary valve

作　　者：屈顺梅[1] 张志芳[1] 张玉奇[1] 董素珍 陈丽君[1] QU Shunmei;ZHANG Zhifang;ZHANG Yuqi;DONG Suzhen;CHEN Lijun(Department of Pediatric Cardiology,Shanghai Children’s Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,P.R.China;Department of Radiology,Shanghai Children’s Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,P.R.China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心内科,上海200127 [2]上海交通大学医学院附属上海儿童医学中心放射科,上海200127

出　　处：《医学影像学杂志》2021年第6期944-948,共5页Journal of Medical Imaging

基　　金：上海交通大学“交大之星”计划医工交叉研究基金项目(编号:YG2019QNB03)。

摘　　要：探讨超声心动图对肺动脉瓣缺如(absent pulmonary valve,APV)的产前诊断价值。方法选取并分析22例经胎儿MRI或出生后超声心动图诊断为APV的产前超声资料。结果APV声像图主要表现为肺动脉瓣叶缺如或发育不良、瓣环狭窄、总干及分支瘤样扩张、肺动脉内双期双向血流。本组合并法洛四联症13例(59.09%),合并其他畸形9例(40.91%),包括室间隔缺损3例、肺动脉狭窄3例、右室双出口2例、三尖瓣下移畸形1例。22例胎儿中动脉导管缺失14例(63.64%),合并动脉导管未闭8例(36.36%);室间隔缺损18例(81.82%),室间隔完整4例(18.18%)。22例胎儿超声诊断正确20例,占90.91%;漏诊2例,占9.09%。结论联合应用四腔心切面、心室流出道切面及三血管气管切面,多普勒超声心动图可以比较准确地诊断胎儿肺动脉瓣缺如,但容易漏诊,需要与单纯肺动脉瓣狭窄鉴别。To evaluate the prenatal diagnostic value for absent pulmonary valve(APV)by Doppler echocardiography.Methods A retrospective echocardiography review of 22 fetuses with APV confirmed by magnetic resonance imaging(MRI)or postnatal echocardiography was conducted.Results APV was presence of a ridge of rudimentary pulmonary valvular tissue at the level of the pulmonary annulus and the aneurysmal dilation of the pulmonary arteries with restrictive anulus with to-and-fro blood flow on color and pulsed-wave Doppler echocardiography.The most common associated anomalies were Tetralogy of Fallot in 13 cases,9 cases with other cardiovascular anomalies,including vertricular septal defect in 3 cases,pulmonary stenosis in 3 cases,double outlet of right ventricle in 2 cases,Ebstein’s anomaly in 1 case.14 cases presented with ductal agenesis and 8 cases with patent ductus arteriosus.18 cases presented with ventricular septal defects and 4 cases with intact ventricular septum.20 of 22 cases(90.91%)were diagnosed correctly,2 cases were missed diagnoses and were found by MRI and postnatal echocardiography.Conclusion APV could be diagnosed accurately by Doppler echocardiography,it is prone to be miss diagnosed and should be distinguished from isolated pulmonary valve stenosis.

关 键 词：超声心动图 胎儿 肺动脉瓣缺如 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]