卵圆孔瓣膨出指数联合心脏大血管Z-评分在单纯性卵圆孔瓣开放过度胎儿中的应用价值  

Application of fetal atrial septal excursion index and comprehensive Z-scores of cardiovascular structures in fetuses with redundancy foramen ovale flap

作　　者：郑洁怀 赵博文[1] 陈欣欣[1] 陈丽炯 彭晓慧 潘美[1] 王蓓[1] Zheng Jiehuai;Zhao Bowen;Chen Xinxin;Chen Lijiong;Peng Xiaohui;Pan Mei;Wang Bei(Department of Diagnostic Ultrasound&Echocardiography,Sir Run Run Shaw Hospital,Zhejiang University College of Medicine,Technical Guidance Center for Fetal Echocardiography of Zhejiang Province&Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,Hangzhou 310016,China;Department of Ultrasound,Taizhou Hospital of Zhejiang Province,Linhai 317000,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,浙江省胎儿心脏超声诊断技术指导中心,浙江大学邵逸夫临床医学研究所,杭州310016 [2]浙江省台州医院超声科,临海317000

出　　处：《中华超声影像学杂志》2022年第6期504-510,共7页Chinese Journal of Ultrasonography

基　　金：浙江省卫生健康委医药卫生科技计划项目(2018RC046)。

摘　　要：目的探讨胎儿卵圆孔瓣膨出指数(ASEI)及心脏大血管Z-评分等心血管多参数在单纯性卵圆孔瓣开放过度(RFOF)胎儿中的应用价值。方法选取2019年12月至2021年9月在浙江大学医学院附属邵逸夫医院经超声心动图诊断为RFOF胎儿22例作为RFOF组,选取同期健康胎儿62例作为对照组。通过四腔心切面观察卵圆孔瓣运动情况,测量卵圆孔瓣膨出最大距离,房间隔总长度,卵圆孔径,主动脉瓣环和肺动脉瓣环以及升主动脉、主动脉峡部、降主动脉内径,左右心室面积。比较两组间ASEI、卵圆孔径、卵圆孔瓣膨出距离、卵圆孔径与房间隔总长比率、主动脉Z-评分(AoV Z-score)、肺动脉Z-评分(PV Z-score)、升主动脉Z-评分(AoA Z-score)、主动脉峡部Z-评分(AoI Z-score)、降主动脉Z-评分(AoD Z-score)、右心室舒张末期面积Z-评分(RV area Z-score)和左心室舒张末期面积Z-评分(LV area Z-score)的差异。并对RFOF胎儿进行随访观察预后。结果RFOF组与对照组胎儿ASEI、卵圆孔径、卵圆孔瓣膨出距离、卵圆孔径与房间隔总长比率、AoV Z-score、PV Z-score、AoA Z-score、AoI Z-score、AoD Z-score、LV area Z-score的差异有统计学意义(均P<0.05);两组间RV area Z-score差异无统计学意义(P>0.05)。RFOF组22例胎儿中有17例(77.3%)出生,5例(22.7%)失访。出生的17例新生儿中有12例(70.5%)超声心动图检查未见明显结构异常。3例(17.6%)超声心动图提示主动脉弓稍窄,临床观察,未处理。2例(11.8%)手术后死亡:其中1例超声心动图提示主动脉弓缩窄、肺动脉增宽、房间隔缺损,手术治疗后感染肺炎死亡;另1例36+4周早产,出生体重2650 g,超声心动图提示主动脉弓缩窄、室间隔缺损、房间隔缺损、动脉导管未闭,手术治疗后死亡。结论ASEI能定量评估卵圆孔瓣开放状态,结合心脏各项参数Z-评分可判断胎儿心脏形态改变。尽管胎儿超声心动图显示部分单纯性RFOF胎儿左、右�Objective To investigate the application of fetal atria septal excursion index(ASEI)combining cardiovascular structure Z-scores in fetuses with redundancy foramen ovale flap(RFOF).Methods Twenty-two fetuses with RFOF diagnosed by fetal echocardiography in Sir Run Run Shaw Hospital from December 2019 to September 2021 were selected as the RFOF group and 62 normal fetuses as the control group.The movement of the foramen ovale valve was observed in the four chamber view,and the maximum distance of the foramen ovale valve bulging,the total length of the atrial septum,the foramen ovale diameter,the diameters of the aortic valve,the pulmonary valve,the ascending aorta,the aortic isthmus,the descending aorta and the left and right ventricular areas were measured.ASEI,foramen ovale diameter,foramen ovale valve excursion distance,the ratio of foramen ovale diameter to total atrial septum length,aortic valvular annular diameter Z-score(AOV Z-score),pulmonary valvular annular diameter Z-score(PV Z-score),ascending aorta diameter Z-score(AOA Z-score),ascending aorta diameter Z-score(AOA Z-score),aortic isthmus Z-score(AOI Z-score),descending aorta diameter Z-score(AOD Z-score),diastolic right ventricular area Z-score(RV area Z-score)and diastolic left ventricular area Z-score(LV area Z-score)were compared between the two groups.RFOF fetuses were followed up to observe the prognosis.Results There were significant differences in fetal ASEI,foramen ovale diameter,foramen ovale valve excursion distance,the ratio of foramen ovale diameter to total atrial septum length,AOV Z-score,PV Z-score,AOA Z-score,AOI Z-score,AOD Z-score and LV area Z-score between RFOF group and control group(all P<0.05),but there was no significant difference in RV area Z-score(P>0.05).Postnatal follow-up outcomes in RFOF group indicated that 17 of 22 cases(77.3%)had live birth,five cases(22.7%)were lost at follow-up.Twelve of 17 live birth cases(70.5%)showed structurally normal heart by postnatal echocardiography,3 cases(17.6%)showed mild coarctation of t

关 键 词：超声心动描记术 胎儿 卵圆孔瓣开放过度 卵圆孔瓣膨出指数 Z-评分 产前诊断 

分 类 号：R714.5[医药卫生—妇产科学]