超声心动图在诊断胎儿A型主动脉弓离断中的应用价值  

The value of echocardiography in the diagnosis of fetal type A interruption of aortic arch

作　　者：王俊香 张雪梅[1] 袁晓华[2] 赵欣[1] 赵颖[1] 娄萍 WANG Junxiang;ZHANG Xuemei;YUAN Xiaohua;ZHAO Xin;ZHAO Ying;LOU Ping(Ultrasound Diagnosis Center,Shaanxi Provincial People's Hospital,Shaanxi Xi'an 710068,China;Department of Obstetrics,Shaanxi Provincial People's Hospital,Shaanxi Xi'an 710068,China)

机构地区：[1]陕西省人民医院超声诊断中心,陕西西安710068 [2]陕西省人民医院产科,陕西西安710068

出　　处：《中国妇幼健康研究》2023年第11期95-100,共6页Chinese Journal of Woman and Child Health Research

基　　金：国家自然科学基金(81200418);陕西省重点研发计划(2022SF-384);陕西省重点研发计划(2023-YBSF-590)。

摘　　要：目的探讨超声心动图在诊断胎儿A型主动脉弓离断(IAA)中的应用价值。方法回顾性分析2013年5月至2022年10月在陕西省人民医院门诊及住院行常规胎儿超声心动图检查的孕妇共27931例,均为单胎妊娠,年龄为20~45岁,超声诊断孕周为21~28周,诊断IAA胎儿共17例,均为A型。对IAA胎儿超声心动图中心脏的左右室流出道、三血管、主动脉弓长轴等切面的主要特征进行归纳总结分析。结果17例A型IAA胎儿的超声心动图特征显示:①主肺动脉内径增宽,平均为(7.90±0.99)mm;升主动脉内径细小,平均为(3.09±0.45)mm;主肺动脉内径与升主动脉内径比值异常偏大,平均为(2.50±0.26);动脉导管内径增宽,平均为(4.35±0.66)mm;室间隔缺损,平均宽度为(2.57±0.42)mm。②主动脉弓长轴切面显示升主动脉走形笔直,与主动脉弓失去正常连接,即左锁骨下动脉远端与降主动脉连续性中断,中断处未见血流通过。③三血管切面显示“V”字结构消失,主肺动脉内径明显增宽,该切面主动脉与降主动脉无法连接,只能通过增宽的动脉导管汇入降主动脉。17例A型IAA胎儿均伴有室间隔缺损,产前超声心动图诊断准确比率占64.71%(11/17);其中2例伴有心内结构复杂畸形(伴单心房、单心室1例,伴主动脉二叶瓣畸形1例),3例合并心外畸形(合并唇腭裂、小脑蚓部缺失1例,合并尿道外生殖器异常1例,合并胎儿多囊肾畸形1例);有3例误诊[主动脉弓缩窄2例,血管环(右位主动脉弓、左位动脉导管及迷走左锁骨下动脉)1例],误诊比率占17.65%(3/17);3例失访,失访比率占17.65%(3/17)。结论三血管切面联合主动脉弓长轴切面是产前超声心动图诊断IAA胎儿的重要方法,应从多个切面顺序联合扫查,该病的超声心动图特征具有很明显的特异性,诊断准确比率较高。Objective To investigate the value of echocardiography in the diagnosis of fetal type A interruption of aortic arch(IAA).Methods A total of 27,931 pregnant women who underwent routine fetal echocardiography in outpatient and inpatient clinics of Shaanxi Provincial People's Hospital from May 2013 to October 2022 were retrospectively analyzed,all of them were singleton pregnancies,aged 20-45 years old,with ultrasound diagnosed gestational weeks ranging from 21 to 28 weeks,and a total of 17 cases of IAA fetuses were found to have A-type.The main features of the right and left ventricular outflow tracts of the heart,the three vessels,and the long axis of the aortic arch in the echocardiographic views of IAA fetuses were summarized and analyzed.Results Echocardiographic features of 17 fetuses with type A IAA showed:①widening of the internal diameter of the main pulmonary artery,with an average of(7.90±0.99)mm.Small internal diameter of the ascending aorta,with an average of(3.09±0.45)mm.Abnormally large ratio of the main pulmonary artery to the ascending aorta,with an average of(2.50±0.26).Widening of the internal diameter of the arterial duct,with an average of(4.35±0.66)mm.And ventricular septal defect,with an average width of(2.57±0.42)mm.②The long-axis view of the aortic arch showed that the ascending aorta was straight and had lost its normal connection with the aortic arch,there was an interruption in the continuity between the distal part of the left subclavian artery and the descending aorta,and no flow was seen through the interrupted area.③The three-vessel view showed the disappearance of the"v"structure and a significant widening of the internal diameter of the main pulmonary artery,in which the aorta could not be connected to the descending aorta and could only flow into the descending aorta through the widened ductus arteriosus.17 cases of A-type IAA fetuses were associated with ventricular septal defects,and the accuracy of the prenatal echocardiography was 64.71%(11/17).Among them,2 cases wer

关 键 词：超声心动图 超声筛查 胎儿 主动脉弓离断 

分 类 号：R714.5[医药卫生—妇产科学]