胎儿冠状静脉窦的超声心动图探讨  

Echocardiographic Evaluation of Coronary Sinus in Fetus

作　　者：张红环[1] 彭宇程[2] 黄泳华[3] 罗中明[3] 杨海玉[2] 

机构地区：[1]江门市中心医院超声心动图室,广东省江门市529070 [2]江门市中心医院心内科,广东省江门市529070 [3]江门市中心医院产科,广东省江门市529070

出　　处：《中国超声医学杂志》2004年第4期299-301,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的　探讨超声心动图探查胎儿冠状静脉窦 (CS)的可行性 ,试图获得妊娠周期中冠状窦大小和血流动力学的正常值范围。方法　对 2 31例孕 2 0～ 4 0周正常胎儿 ,分别行左室长轴观、心尖二腔观、非标准心尖四腔心及右室流入道切面对 CS长、短轴进行实时显像 ,用 M-型超声测量 CS舒张期、收缩期最大内径 ,应用脉冲多普勒观测频谱形态和流速。结果　心尖非标准四腔心 ,右室流入道切面分别是检测胎儿 CS内径变化和血流动力学的最佳切面。其最大收缩期内径从 2 0周的 (1.5 0± 0 .2 5 ) mm到 4 0周的 (3.91± 0 .31) mm;最大舒张期内径从 2 0周的 (0 .82± 0 .0 8) mm到 4 0周的 (2 .13± 0 .10 )mm。在 2 31例胎儿心脏中能成功检测到 CS脉冲多普勒 4 2例 ,检测成功率 18.2 %。其频谱特点为三相 ,收缩期和舒张期流向心房血流的正向 S波和 D波 ,以及心房收缩期离开心房逆流的倒置小 A波。其收缩期流速 ,舒张期流速及心房收缩波流速分别是(18.10± 2 .76 ) cm/s、 (33.2 0± 3.5 2 ) cm/s、 (8.4 0± 1.87) cm/s。结论　胎儿 CS的超声检查是可行的。正常胎儿 CS在心动周期中有收缩和舒张性变化 ,且内径随着孕周增大而明显增大 ;部分胎儿能较为满意地评价 CS血流动力学变化 ,其频谱类似肺静脉的三相频谱。Objective:This study was designed to detect the coronary sinus(CS) in the fetus using echocardiography and to get the normal values of the CS size and flow dynamics during the gestation.Methods:The study group included 231 normal fetuses undergoing fetal echocardiography from the 20 th to the 40 th weeks of gestation.The CS was visualized on real-time ultrasound from long-axis of left ventricular,apical two-chamber,apical non-standard four-chamber and right ventricular inflow tract views.Maximum systolic and diastolic diameters were measured with M-mode ultrasound.Blood flow of CS was measured with pulsed wave Doppler.Results:Apical non-standard four-chamber and right ventricular inflow views were optimal planes for CS on echocardiography.The maximum systolic diameter of CS was from 1.50±0.25 mm at the 20 th week to 3.91±0.31 mm at the 40 th week,and maximum diastolic diameter was from 0.82±0.09 mm at the 20 th week to 2.13±0.10 mm at the 40 th week.The flow of CS was visualized with pulsed Doppler in 42 of 231(18.2%) fetuses.The flow spectrum of CS was a triphasic waveform.There were antegrade S and D waves towards the right atrium during systolic and diastolic period,and a reverse A wave during atrial contraction.The peak blood flow velocities of the three were 18.10±2.76 cm/s,33.20±3.52 cm/s,and 8.40±1.87 cm/s,respectively.Conclusions:The fetal CS can be feasibly identified on echocardiography.The displayed normal fetal CS size changes along with the cardiac cycle.Its diameter increased accordingly with gestations.CS flow pattern is similar to that in pulmonary veins.

关 键 词：胎儿 冠状静脉窦 超声心动图 血流动力学 

分 类 号：R445.1[医药卫生—影像医学与核医学]