孤立性三尖瓣发育不良的产前超声心动图诊断  

Prenatal diagnosis of isolated tricuspid valve dysplasia by echocardiography

作　　者：杨培枝 耿斌[2] 李文秀[2] 史莉玲 王燕 张瑞 Yang Peizhi;Geng Bin;Li Wenxiu;Shi Liling;Wang Yan;Zhang Rui(Department of Medical Inspection,Children′s Hospital of Shanxi,Women Health Center of Shanxi,Taiyuan 030013,China;Pediatric Cardiovascular Center,Beijing Anzhen Hospital Affiliated to the Capital Medical University,Beijing 100029,China)

机构地区：[1]山西省儿童医院山西省妇幼保健院综合检查科,太原030013 [2]首都医科大学附属北京安贞医院小儿心脏中心,100029

出　　处：《中华超声影像学杂志》2021年第8期685-690,共6页Chinese Journal of Ultrasonography

基　　金：山西省儿童医院科研课题(201529)。

摘　　要：目的探讨孤立性三尖瓣发育不良(TVD)的产前超声心动图特征,提高TVD的产前诊断准确率。方法回顾性分析2012年6月至2020年12月于首都医科大学附属北京安贞医院小儿心脏中心及山西省儿童医院产前诊断的7例TVD胎儿的超声心动图表现,总结TVD胎儿期的超声心动图特征。结果7例TVD胎儿中,6例合并室间隔完整的肺动脉瓣功能性闭锁并不同程度的肺动脉瓣反流,1例合并肺动脉发育细。TVD胎儿超声心动图特征为:①心轴明显左偏,心胸比值明显增大,右心增大,其中右心房显著扩大(本畸形重要特征);②三尖瓣瓣环位置正常,各瓣叶附着点正常,部分三尖瓣瓣叶增厚并关闭不全;③易合并室间隔完整的肺动脉瓣功能性闭锁或肺动脉瓣重度狭窄;④彩色多普勒显示三尖瓣大量反流,流速<350 cm/s(本畸形重要特征);⑤合并室间隔完整的肺动脉瓣功能性闭锁时,彩色多普勒显示动脉导管血流逆灌入肺动脉,肺动脉瓣可见不同程度的肺动脉瓣反流。结论胎儿期TVD具有典型超声心动图特征,主要为三尖瓣大量反流及右心房显著扩大,合并肺动脉瓣功能性闭锁时预后较差,早期诊断对产前咨询及预后评估至关重要。Objective To improve the prenatal recognition and diagnostic accuracy of isolated tricuspid valve dysplasia(TVD)by analyzing fetal echocardiographic features.Methods The fetal echocardiographic features of 7 cases with prenatal diagnosis of TVD were analyzed retrospectively in Pediatric Cardiovascular Center,Beijing Anzhen Hospital,Capital Medical University and Children′s Hospital of Shanxi from June 2012 to December 2020.The fetal echocardiographic characteristics of TVD were summarized.Results Among the 7 fetuses with TVD,6 cases showed functional pulmonary atresia with intact ventricular septum and different degrees of pulmonary valve regurgitation,and 1 case showed slightly narrowed pulmonary artery.Characteristic sonographical findings included:①The axis of heart was exaggerated left-axis deviation and the ratio of cardiothoracic was obviously increased.The right heart was enlarged,in which the right atrium was significantly dilated(an important feature of TVD).②The position of tricuspid valve ring was normal,the attachment point of each leaf was normal,some tricuspid valves were thickened and insufficiency.③It was common to be complicated with functional pulmonary valve atresia with intact ventricular septum or severe pulmonary valve stenosis.④Color Doppler imaging showed severe tricuspid regurgitation and the regurgitation velocity was less than 350 cm/s(an important feature of TVD).⑤In fetus with functional pulmonary valve atresia with intact ventricular septum,color Doppler imaging showed retrograded ductal flow across the pulmonary artery and the different degrees regurgitation of pulmonary valve.Conclusions Fetal TVD has typical echocardiographic features,mainly including large tricuspid regurgitation and significant enlargement of the right atrium.The prognosis of fetus with functional pulmonary atresia is poor.Early diagnosis plays a crucial role in prenatal consultation and prognosis evaluation.

关 键 词：超声心动描记术 产前 三尖瓣发育不良 三尖瓣反流 肺动脉瓣闭锁 

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