产前诊断大动脉失调胎儿的预后  

Prenatal prognosis of fetuses with transposition of the great arteries

作　　者：任洁 杨冬妹 黄向阳 张超学[2] 汪春林 何小燕 REN Jie;YANG Dongmei;HUANG Xiangyang;ZHANG Chaoxue;WANG Chunlin;HE Xiaoyan(Department of Echocardiography,The First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China;Department of Ultrasound,First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)超声心动图室,安徽合肥230000 [2]安徽医科大学第一附属医院超声医学科,安徽合肥230022

出　　处：《分子影像学杂志》2025年第2期180-185,共6页Journal of Molecular Imaging

摘　　要：目的评估产前诊断为大动脉失调但最终没有发生主动脉缩窄(CoA)的胎儿的产后结局。方法从安徽省立医院和安徽医科大学第一附属医院2个胎儿产前超声诊断中心提取2019年1月~2023年3月所有产前诊断为主动脉-肺动脉比例失调的275例患者的资料,根据产后随访情况,其中93例(34%)确诊CoA作为CoA组,182例(66%)没有发生CoA作为非CoA组。另外选取正常妊娠149例作为正常组。分析3组病例的产前资料、产后随访情况以及胎儿的生存曲线,探讨产后结局的可能影响因素。结果在非CoA组中,排除合并心内或心外畸形的胎儿后,单纯性大动脉比例不协调胎儿的预后良好,远期生存率与正常胎儿的差异无统计学意义(P>0.05)。CoA组与非CoA组中活产的婴儿远期生存率差异无统计学意义(P>0.05),长期生存率较好。合并心内和心外畸形是大动脉比例不协调胎儿产后预后不良的影响因素。与正常组相比,二叶式主动脉瓣婴儿的主动脉瓣环偏小,主动脉瓣口血流速度偏快(P<0.05)。结论产前诊断大动脉失调胎儿的预后与合并的心内和心外畸形密切相关,单纯性主动脉、肺动脉比例不协调胎儿预后良好。主动脉瓣先天二叶式畸形的婴儿建议长期随访。Objective To assess the postnatal outcomes of fetuses diagnosed with large artery dysfunction but ultimately without developing coarctation of the aorta(CoA).Methods A total of 275 cases of prenatal diagnosis of aorto-pulmonary imbalance from January 2019 to March 2023 were extracted from two fetal prenatal ultrasound diagnostic centers of Anhui Provincial Hospital and the First Affiliated Hospital of Anhui Medical University.According to the postpartum follow-up,93 cases(34%)were diagnosed with CoA as the CoA group.The non-CoA group included 182 patients(66%)without CoA.Another 149 cases of normal pregnancy were selected as the normal group.The prenatal data,postpartum follow-up and fetal survival curves of the three groups were analyzed to explore the possible influencing factors of postpartum outcomes.Results In the non-CoA group,after eliminating the fetuses with combined intracardiac or extracardiac malformations,the prognosis of fetuses with simple aortic disproportion was favorable,and there was no statistically significant difference in the long-term survival rate compared with normal fetuses(P>0.05).The same was true for the CoA group compared with the non-CoA group(P>0.05),with better long-term survival.The combination of intracardiac and extracardiac malformations was an influencing factor for the poor postnatal prognosis of fetuses with aortic disproportion.Compared with the normal group,infants with bicuspid aortic valve had a smaller aortic annulus and a faster blood flow velocity at the aortic valve orifice,and the differences were statistically significant(P<0.05).Conclusion The prognosis of fetuses prenatally diagnosed with large artery disorders is closely related to the combined intracardiac and extracardiac malformations.The prognosis of fetuses with isolated aortapulmonary incoordination is good.Long-term follow-up is recommended for infants with congenital bicuspid aortic valves.

关 键 词：胎儿超声心动图 大动脉比例失调 主动脉缩窄 产前诊断 

分 类 号：R714.5[医药卫生—妇产科学]