2017 年第 12 期 第 12 卷

产前超声心动图冠状切面在胎儿先天性心血管畸形诊断中的应用价值

Value of prenatal echocardiographic coronal view in diagnosis of fetal congenital cardiovascular malformation

作者：吴江耿斌苏俊武李文秀杨爽        

英文作者：Wu Jiang Geng Bin Su Junwu Li Wenxiu Yang Shuang

单位：100029首都医科大学附属北京安贞医院小儿心脏中心北京市心肺血管疾病研究所

英文单位：Pediatric Cardiac Center Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：先天性心血管畸形；血管环；胎儿超声心动图；冠状切面

英文关键词：Congenitalcardiovascularanomaly；Vascularring；Fetalechocardiography；Coronalview

• 摘要：

• 目的    探讨超声心动图冠状切面在胎儿先天性心血管畸形诊断中的应用价值。方法    选取2014年1月至2017年7月于首都医科大学附属北京安贞医院小儿心脏中心产前超声心动图检出并经产后证实的先天性心血管畸形胎儿70例，包括不同类型先天性血管环51例、主肺动脉间隔缺损7例、单纯性完全性肺静脉异位引流12例，回顾分析其产前常规超声切面、三血管气管切面及冠状切面对先天性心血管畸形的超声图像特征，总结冠状切面对提高胎儿不同类型畸形的诊断准确性的价值。结果    ①加用冠状切面后，镜面右位主动脉弓形成的血管环及右位主动脉弓伴迷走左锁骨下动脉之左锁骨下动脉的显示率均明显提高，对右位主动脉弓伴左位动脉导管与双主动脉弓的鉴别性提高，但对双主动脉弓诊断无明显差别；②冠状切面可清晰显示主肺动脉间隔缺损长度及与2组半月瓣间的距离；③冠状切面可显示异位引流的静脉弓走行，并通过叠加彩色多普勒显示是否存在梗阻。结论    超声心动图冠状切面可提供辅助、甚至关键的诊断信息，对提高胎儿先天性心血管畸形诊断的准确性具有重要的临床价值。

• Objective    To investigate the application value of echocardiographic coronal view in diagnosis of fetal congenital cardiovascular malformation. Methods    Totally 70 fetuses with congenital cardiovascular malformation, induding 51 cases of congenital vascular ring, 7 cases of aorto-pulmonary septal defect and 12 cases of isolated total anomalous pulmonary venous drainage screened by echocardiography before birth in Pediatric Cardiac Center, Beijing Anzhen Hospital, Capital Medical University from January 2014 to July 2017 were retrospectively analyzed. Images of routine echocardiographic view, three vessels and trachea view and coronal view were analyzed to evaluate the diagnostic value of coronal view for different types of fetal anomalies. Results    ①With combined use of coronal view, display rates of vascular ring formed by right aortic arch and the left subclavian artery in RAA accompanied by aberrant left subclavian artery were significantly increased; the discriminability between right aortic arch accompanied by left ductus arteriosus and double aortic arches was also improved; but the detectability of double aortic arches was almost the same compared with routine echocardiographic view. ②Images of coronal view could clearly show the length of aorto-pulmonary septal defect and the distance between 2 groups of semilunar valves. ③Imagine of coronal view could show the shape of anomalous venous arch; superimposed color Doppler could show the obstruction. Conclusion    Echocardiographic coronal view can provide auxiliary and useful information for improving diagnostic accuracy of fetal congenital cardiovascular malformation.