胎儿心内型完全型肺静脉异位引流的产前超声特征总结  

Prenatal echocardiographic characteristics of fetal intracardiac total anomalous pulmonary venous connection

作　　者：何敏瑜 冉素真[1] Minyu He;Suzhen Ran(Department of Ultrasound,Chongqing Health Center for Women and Children(Women and Children’s Hospital of Chongqing Medical University),Chongqing 401120,China)

机构地区：[1]重庆市妇幼保健院(重庆医科大学附属妇女儿童医院)超声科,401120

出　　处：《中华医学超声杂志(电子版)》2024年第11期1017-1023,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：重庆市妇幼疾病预防控制与公共卫生研究中心开放课题(CQFYZD01001)。

摘　　要：目的总结胎儿心内型完全型肺静脉异位引流(TAPVC)的产前超声扫查思路、诊断要点,以期为产前筛查机构诊断心内型TAPVC提供一定的快速筛查思路。方法回顾性分析2017年1月至2024年1月于重庆市妇幼保健院行产前超声心动图诊断的54例心内型TAPVC胎儿的产前超声资料,分析产前超声特征、合并畸形情况、随访结果,总结快速筛查要点,采用描述性统计分析。结果54例心内型TAPVC胎儿中,所有胎儿四腔心切面左心房未探及肺静脉开口;23例(42.59%)左心房与降主动脉间见肺静脉总腔;22例(40.74%)四腔心比例异常;22例(40.74%)冠状静脉窦增宽;48例(88.89%)左心房后间隙指数>1.0。54例胎儿中34例(62.96%)合并其他复杂心血管畸形,其中右侧异构综合征最常见(42.59%,23/54)。产前超声诊断的54例心内型TAPVC胎儿中:41例引产,7例出生(6例生后手术证实,1例生后超声证实并观察随访中),1例死产(为双胎之一),5例失访。41例引产病例中,3例尸检后证实。结论产前超声发现左心房后壁光滑、心腔比例异常、左心房和降主动脉间距增宽、冠状静脉窦扩张时,要考虑心内型TAPVC的可能。ObjectiveTo summarize the echocardiographic characteristics of intracardiac total anomalous pulmonary venous connection (TAPVC), in order to provide prenatal screening institutions with some rapid screening ideas for this condition.MethodsThis retrospective study included 54 cases of fetuses with intracardiac TAPVC diagnosed by prenatal echocardiography in our hospital from January 2017 to January 2024. The analysis focused on prenatal ultrasound characteristics, concomitant malformations, and follow-up. Descriptive statistical analysis was utilized for this purpose.ResultsAmong the 54 fetuses with intracardiac TAPVC included, all (100%) exhibited no detection of pulmonary vein openings in the left atrium on the four-chamber view, 23 (42.59%) had a common pulmonary venous chamber observed between the left atrium and the descending aorta, 22 (40.74%) showed abnormal four-chamber proportions, 22 (40.74%) had a dilated coronary sinus, and 48 (88.89%) had a left atrium posterior space index greater than 1.0. Among the 54 cases, 34 (62.96%) had other complex cardiovascular malformations, of which right-sided heterogeneous syndrome was the most common concomitant abnormality (n=23, 42.59%). Among the 54 fetuses who were followed, 41 underwent induced labor, 7 were born (6 confirmed by postnatal surgery and 1 by postnatal ultrasound, with ongoing observation and follow-up), 1 was stillborn (one of the twins), and 5 were lost to follow-up. Among the 41 cases of induced labor, 3 were confirmed by autopsy.ConclusionFetal prenatal echocardiography with two-dimensional and low-velocity flow imaging can diagnose intracardiac TAPVC and associated malformations. When prenatal ultrasound findings show a smooth posterior wall of the left atrium, abnormal cardiac chamber proportions, increased spacing between the left atrium and descending aorta, and dilated coronary sinus, the possibility of intracardiac pulmonary venous anomalous connection should be considered.

关 键 词：肺静脉异位引流 心内型 产前超声 

分 类 号：R71[医药卫生—妇产科学]