超声心动图诊断胎儿单纯肺动脉瓣狭窄的价值  

Value of echocardiography in diagnosis of isolated fetal pulmonary valvular stenosis

作　　者：李博[1] 彭芳华 孔德璇 张欢欢 曲东辉 王锟 阚长利[1] 聂明辉[1] 刘天鑫 吴文瑛[1] Bo Li;Fanghua Peng;Dexuan Kong;Huanhuan Zhang;Donghui Qu;Kun Wang;Changli Kan;Minghui Nie;Tianxin Liu;Wenying Wu(Department of Ultrasound,Affiliated Hospital of Chengde Medical University,Chengde 067000,China)

机构地区：[1]承德医学院附属医院超声科,067000

出　　处：《中华医学超声杂志（电子版）》2024年第2期158-162,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨超声心动图在诊断胎儿单纯肺动脉瓣狭窄(PVS)中的价值。方法回顾性分析2019年1月至2022年12月在天津市中心妇产科医院超声科和承德医学院附属医院南区超声科产前经超声心动图诊断为单纯PVS的胎儿35例。胎儿心脏超声检查获取四腔心切面、左心室及右心室流出道切面、三血管切面等。测量各心腔横径,观察房室瓣启闭及反流情况。出生的胎儿均于产后24 h内行超声心动图检查,测量肺动脉速度和肺动脉跨瓣压差,评估肺动脉瓣狭窄程度。分析产前和产后超声心动图检查结果,采用Pearson相关分析产前PVS分组(正向组、逆向组)与产后PVS分度(轻、中、重度)之间的相关性。结果35例单纯PVS胎儿引产8例,出生27例。产前动脉导管(DA)正向组15例,逆向组20例,2组病例肺动脉流速、肺动脉狭窄后扩张和三尖瓣反流程度差异具有统计学意义(P<0.05)。肺动脉内径,左、右肺动脉内径,肺动脉瓣开口和右心室横径/左心室横径差异无统计学意义(P>0.05)。27例出生后新生儿期超声心动图检查均证实有不同程度PVS,轻度15例,中度8例,重度4例。产前PVS不同分组与产后PVS不同分度之间具有相关性(Pearson相关系数=0.58,P<0.05),产前正向组病例产后大部分为轻度PVS(12/14,85.71%),逆向组病例产后中度和重度PVS居多(10/13,76.92%)。结论胎儿单纯PVS肺动脉流速快,三尖瓣反流程度重,DA逆灌产后可能中度以上PVS的可能性大,狭窄后扩张是胎儿PVS的一个重要间接征象。胎儿单纯PVS可以在产前进行诊断,超声心动图是诊断胎儿单纯PVS并预估其产后分度的重要手段。Objective To assess the value of echocardiography in the diagnosis of isolated fetal pulmonary valvular stenosis(PVS).Methods From January 2019 to December 2022,35 fetuses diagnosed with PVS by prenatal echocardiography at the Department of Ultrasound of Tianjin Central Obstetrics and Gynecology Hospital and the Department of Ultrasound of Southern District of Chengde Medical College were retrospectively analyzed.Fetal echocardiography was performed to obtain four chamber sections,left ventricular and right ventricular outflow tract sections,and three vessel sections.The transverse diameter of each heart cavity was measured,and the opening and closing of the atrioventricular valve and regurgitation were observed.All fetuses were examined by echocardiography within 24 h after delivery to measure pulmonary artery velocity and pulmonary artery cross-valve pressure difference and evaluate the degree of pulmonary artery stenosis.The results of prenatal and postnatal echocardiography were analyzed,and Pearson correlation was used to analyze the correlation between prenatal PVS grouping(forward group and reverse group)and postpartum PVS grading(mild,moderate,and severe).Results Of the 35 fetuses with PVS included,8 underwent induced labor and 27 were born.There were 15 cases in the forward prenatal ductus arteriae(DA)group and 20 cases in the reverse prenatal DA group,and there were statistically significant differences in pulmonary artery velocity,dilation of the pulmonary artery after stenosis,and tricuspid regurgitation between the two groups(P<0.05).There was no significant difference in pulmonary artery diameter,left and right pulmonary artery diameter,pulmonary valve opening,and right ventricular diameter/left ventricular diameter ratio(P>0.05).All 27 cases of PVS in neonatal period were confirmed by echocardiography,of which 15 were mild,8 were moderate,and 4 were severe.There was a correlation between different groups of prenatal PVS and different grades of postpartum PVS(Pearson correlation coefficient=0.58,P<0

关 键 词：超声心动图 胎儿 肺动脉瓣狭窄 产前 产后 

分 类 号：R540.45[医药卫生—心血管疾病] R714.5[医药卫生—内科学]