超声观察后四腔心切面上冠状静脉窦管壁形态特征对胎儿冠状静脉窦扩张分类剖析  

Value of morphological characteristics of the dilated fetal coronary sinus in apical four-chamber view for etiological diagnosis

作　　者：唐娟松 黎新艳[1] 何桂丹 TANG Juan-song;LI Xin-yan;HE Gui-dan(Department of Ultrasound,Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital(Guangxi Fetal Disease Clinical Medical Research Center),Nanning Guangxi 530002,China)

机构地区：[1]广西壮族自治区妇幼保健院(广西胎儿疾病临床医学研究中心)超声科,广西南宁530002

出　　处：《临床和实验医学杂志》2022年第13期1434-1437,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金(编号:82060322);广西壮族自治区卫生和计划生育委员会自筹经费课题(编号:Z2016106)。

摘　　要：目的通过超声观察后四腔心切面上冠状静脉窦(CS)管壁形态特征以剖析胎儿CS扩张的分类情况。方法回顾性分析2017年1月至2021年10月在广西壮族自治区妇幼保健院行胎儿心脏检查的927例孕妇临床资料。将检出的CS扩张胎儿按病因分永存左上腔静脉、心内型完全型肺静脉异位引流、静脉导管回流至CS、无顶CS综合征、右心病变5种常见类型,分别记A、B、C、D、E型;分析5组在后四腔心切面上管壁的形态与病因间的关系,提出确定的鉴别要点。结果经后四腔心切面显示,共检出103例胎儿CS扩张,胎儿出生后经超声心动图或引产后病理解剖证实,其中A型73例(70.87%),B型4例(3.88%),C型5例(4.85%),D型4例(3.88%),E型17例(16.50%)。5组CS扩张胎儿后四腔心切面上的最大内径差异无统计学意义(P>0.05)。A型CS对称扩张,前后管壁平衡完整,呈大等号征;B型前后壁远端呈弧形,连接肺总静脉腔管壁,呈烟斗状;C型CS不对称扩张,前壁走行平直,后壁由中部往后方膨出,呈孕肚征;D型CS前壁完整、平直,后壁出现缺损,呈缺口征;E型CS形态类似A型,对称性扩张,但幅度较小,呈小等号征。结论胎儿CS扩张的不同分类在后四腔心切面上显示其管壁形态有不同特征,产前超声可提高胎儿这些畸形的诊断率。Objective To analyze the classification of fetal CS dilatation by observing the morphological characteristics of coronary sinus(CS)tube wall on the posterior four chamber view.Methods The clinical data of 927 pregnant women underwent fetal malformation screening and echocardiogram examination in our hospital from January 2017 to October 2021 were retrospectively analyzed.Patients with CS dilation were classified into five types according to their primary cardiovascular malformations:left superior vena cava,intracardiac total anomalous pulmonary venous connection,venous catheter,unroofed coronary sinus syndrome and lesions of right heart system,and were noted as types A,B,C,D and E.The morphological characteristics of the dilated CS in apical four-chamber view were analyzed,and its relationship with etiology was discussed,and the main differential points were summarized.Results Apical four-chamber view revealed a total of 103 cases of fetal CS dilatation,which were confirmed by echocardiography or pathological autopsy after induction of labour,including 73 cases(70.87%)of type A,4 cases(3.88%)of type B,5 cases(4.85%)of type C,4 cases(3.88%)of type D and 17 cases(16.50%)of type E.The maximum diameter on apical four-chamber view yielded no statistical difference among five types(P>0.05).The fetus with type A CS dilation showed"big equal"sign,showing symmetrical dilation,and the anterior and posterior walls were balanced and complete.Type B showed"tobacco pipe-shaped"sign,showing an arched distal anterior and posterior wall connecting the common pulmonary venous lumen wall.Type C showed"abdominal swelling"sign,showing asymmetrical dilatation with anterior wall aligned in a straight line and posterior wall swelling from the middle to the rear.Type D showed notch sign,showing an intact anterior wall with a linear alignment and a partial defect in the posterior wall.Type E showed"small equal"sign,showing a similar morphology to type A,symmetrically dilated but with less amplitude.Conclusion Fetal CS dilatation of differ

关 键 词：冠状静脉窦 超声 后四腔心切面 管壁形态特征 病因剖析 

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]