胎儿孤立性卵圆孔瓣冗长的超声心动图研究分析  

Fetal echocardiographic study of isolated redundant foramen ovale valve

作　　者：李云桃[1] 闫亚妮[1] 杨振娟[1] 薛小伟 裴秋艳[1] LI Yuntao;YAN Yani;YANG Zhenjuan;XUE Xiaowei;PEI Qiuyan(Department of Obstetric Department,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院妇产科,北京100044

出　　处：《中国妇产科临床杂志》2023年第5期503-505,共3页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家卫生健康委妇幼司(2127000280)。

摘　　要：目的探讨胎儿孤立性卵圆孔瓣冗长的产前超声特征,并通过卵圆孔瓣M超运动轨迹分析其产生右心功能衰竭、左心减小的原因。方法对59例孤立性卵圆孔瓣冗长的超声心动图进行分析,应用M超分析卵圆孔瓣运动曲线并随访妊娠结局及预后。结果59例胎儿孤立性卵圆孔瓣冗长超声心动图显示四腔心切面卵圆孔瓣过度突入左心房,左房室腔减小;严重时卵圆孔瓣可达左心房游离壁,右心增大,少数出现右心功能衰竭。卵圆孔通道切面显示卵圆孔瓣尖开放受限,严重时无血流通过,M超运动轨迹由S、A、D、B四点构成,其中S点发生在心室收缩早期,距左心房游离壁距离最近,13例达左心房游离壁,46例未达左心房游离壁但≥2/3左心房横径。59例中,2例新生儿死亡,均为胎儿期卵圆孔瓣达左心房游离壁的病例,余57例胎儿均足月分娩,生长发育好。结论孤立性卵圆孔瓣冗长的典型表现是左房室腔减小、卵圆孔瓣过度膨向左心房、卵圆孔瓣尖开放受限。大部分胎儿预后良好,当卵圆孔瓣达左心房游离壁时,胎儿心功能衰竭、新生儿死亡的风险增加,因此,对卵圆孔瓣达左心房游离壁的胎儿应加强监测,定期超声心动图检查,减少死亡率,提高生存质量。Objective To explore the prenatal ultrasound features of fetal isolated redundant foramen ovale valve,and to analyze the cause of small left heart and right heart failure through the motion trajectory of the foramen ovale valve using M-ultrasound.Methods 59 cases of isolated redundant foramen ovale valve were analyzed using echocardiography.M-ultrasound was used to analyze the motion curve of the foramen ovale valve,and pregnancy outcomes and prognosis were followed up.Results 59 cases of fetal isolated redundant foramen ovale valve showed excessive protrusion of the foramen ovale valve into the left atrium and small left heart in the four chamber view on echocardiography;In severe cases,the foramen ovale valve can reach the lateral wall of the left atrium,leading to enlargement of the right heart,and a few cases of right heart failure.The section of the foramen ovale channel shows that the opening of the foramen ovale valve tip is restricted,and in severe cases,there is no blood flow passing through.The motion trajectory of M-ultrasound consists of four points:S,A,D,and B.The S point occurs in the early period of ventricular systole,and is closest to the lateral wall of the left atrium.13 cases reach the wall of the left atrium,and 46 cases do not reach the wall of the left atrium,but≥2/3 of the left atrial transverse diameter.Among the 59 cases,2 newborns died,both of which were cases of fetal right heart failure and foramen ovale valve reaching the wall of the left atrium.The remaining 57 fetuses were delivered at full term with good growth and development.Conclusion Most fetuses with isolated redundant foramen ovale valve have a good prognosis.When the foramen ovale valve reaches the lateral wall of the left atrium,the risk of fetal heart failure and neonatal death increases.Therefore,fetuses with foramen ovale valve reaching the lateral wall of the left atrium should strengthen monitoring and undergo regular echocardiography to reduce mortality and improve quality of life.

关 键 词：胎儿 超声心动图 卵圆孔瓣冗长 

分 类 号：R714.5[医药卫生—妇产科学]