胎儿先天性左心室膨出病变产前超声诊断及临床结局  

Autopsy and Postnatal Follow-up of Prenatally Diagnosed Left Ventricular Outpouchings

作　　者：郑敏 孙琳[1] 何怡华[1] Zheng Min;Sun Lin;He Yihua(Beijing Anzhen Hospital Heart Ultrasound Medical Center Affiliated to Capital Medical University,Beijing Anzhen Hospital Fetal Heart Disease Maternal and Fetal Medical Center,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏超声医学中心、北京安贞医院胎儿心脏病母胎医学中心,北京市100029

出　　处：《中国超声医学杂志》2023年第3期295-298,共4页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金(No.U21A20523);NSFC区域(广东)联合基金重点支持项目。

摘　　要：目的 分析本中心胎儿先天性左心室膨出(VO)病变(包括先天性室壁瘤和先天性憩室)的超声心动图特点及随访预后,探索发病原因。方法 对产前诊断为左心室VO的患者进行回顾性研究并随访。结果 共15例左心室VO患儿入组,其中3例诊断为先天性室壁瘤,10例诊断为先天性憩室,2例不确定类型。80%的VO位于左心室心尖。VO的平均尺寸为146.4(53.1,163.6)mm^(2),颈部平均直径为(6.3±2.2)mm。共4例患儿出生,产前诊断均为憩室。生后复查发现3例位于左心室心尖的VO仍然存在,而位于左心室中间段的VO在患儿1岁时消失。1例先天性室壁瘤患儿尸检结果提示存在心肌缺血。结论 产前超声心动图在胎儿先天性心室膨出病变的诊断中起着关键作用,先天性室壁瘤可能由心肌缺血后梗死引起。Objective To analyze the echocardiographic characteristics and follow-up prognosis of fetal congenital left ventricular outpouchings(VOs, including congenital ventricular aneurysm and congenital ventricular diverticulum) in our center and to explore the causes of incidence. Methods A retrospective study and follow up were conducted for patients with a prenatal diagnosis of left VO at our hospital.Results A total of 15 cases with left VO were enrolled, of which 3 were diagnosed with congenital ventricular aneurysms, 10 with congenital diverticula, and 2 with indeterminate type. 80% of VOs were located in the left ventricular apex. The average size of VO was 146.4(53.1,163.6)mm^(2) and the average neck diameter was(6.3±2.2) mm. A total of 4 patients were born with a prenatal diagnosis of diverticula. Postnatal echocardiography showed that the outpouchings located in the left ventricular apex were still present in 3 cases, while the outpouching located in the middle segment of the left ventricle disappeared by the time the patients were 1 year old. One fetus with a congenital ventricular aneurysm underwent an autopsy examination. Histopathology showed the presence of myocardial ischemia. Conclusions Prenatal echocardiography plays a key role in the diagnosis of fetal congenital VO, which may be caused by myocardial ischemia.

关 键 词：超声心动描记术 心室憩室 心室室壁瘤 先天性心脏病 预后 胎儿 

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]