孕11～13~(+6)周心脏畸形胎儿四腔心切面声像图特征
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摘要
目的观察孕11～13~(+6)周心脏畸形胎儿四腔心切面声像图特征,探讨其在早孕期筛查中的价值。方法回顾性分析24胎经病理、中孕期胎儿超声心动图检查或出生后随访证实的11～~(13+6)周心脏复杂畸形胎儿心脏四腔心切面超声声像图特征和颈项透明层(NT)厚度。结果 24胎心脏畸形胎儿早孕期四腔心切面表现:(1)6胎正常,可见2束比例相当的心室流入道血流;(2)3胎表现为比例失调的2束血流;(3)5胎仅显示1束房室瓣血流,于心室水平再分为左右2束血流;(4)5胎显示1束房室瓣血流,于心室水平无分叉;(5)5胎表现为室间隔过隔血流。24胎中,16胎(16/24,66.67%)NT增厚,8胎(8/24,33.33%)NT正常。结论 11～13+6周四腔心切面超声表现对筛查胎儿心脏畸形具有一定价值,有望将部分心脏畸形的检查时间窗由中孕期提前至早孕期。
Objective To observe the ultrasonic features of four chamber heart(4 CH)view in 11—13+6 weeks fetuses with congenital heart malformations,and to explore their value in fetal malformation screening in the first trimester.Methods Totally 24 fetuses with congenital heart malformations confirmed with pathology or echocardiography in the second trimester or postpartum follow-up were enrolled,and the ultrasonic imaging features and nuchal translucency(NT)value in 11—13+6 weeks were retrospectively analyzed.Results In all 24 fetuses,18 fetuses(18/24,75.00%)were abnormal in 4 CH views in the first trimester.There were 5 different ultrasonic imaging features of in 4 CH views in the first trimester of 24 fetuses,including normal view in 6 fetuses showing 2 proportional ventricular inflows,2 disproportionate ventricular inflows in 3 fetuses,the initially 1 shared inflows,but 2 flows in the ventricular level in 5 fetuses,the singular inflows and no bifurcate at the ventricular level in 5 fetuses,the transseptal flows in 5 fetuses.Sixteen fetuses(16/24,66.67%)were found with increased NT,and 8(8/24,33.33%)with normal NT.Conclusion Ultrasonic features of4 CH view in 11—13+6 weeks are of certain value in detection of fetal heart malformations,which are expected to advance the inspect period of some heart defects from the second trimester to the first trimester.
Objective To observe the ultrasonic features of four chamber heart(4 CH)view in 11—13+6 weeks fetuses with congenital heart malformations,and to explore their value in fetal malformation screening in the first trimester.Methods Totally 24 fetuses with congenital heart malformations confirmed with pathology or echocardiography in the second trimester or postpartum follow-up were enrolled,and the ultrasonic imaging features and nuchal translucency(NT)value in 11—13+6 weeks were retrospectively analyzed.Results In all 24 fetuses,18 fetuses(18/24,75.00%)were abnormal in 4 CH views in the first trimester.There were 5 different ultrasonic imaging features of in 4 CH views in the first trimester of 24 fetuses,including normal view in 6 fetuses showing 2 proportional ventricular inflows,2 disproportionate ventricular inflows in 3 fetuses,the initially 1 shared inflows,but 2 flows in the ventricular level in 5 fetuses,the singular inflows and no bifurcate at the ventricular level in 5 fetuses,the transseptal flows in 5 fetuses.Sixteen fetuses(16/24,66.67%)were found with increased NT,and 8(8/24,33.33%)with normal NT.Conclusion Ultrasonic features of4 CH view in 11—13+6 weeks are of certain value in detection of fetal heart malformations,which are expected to advance the inspect period of some heart defects from the second trimester to the first trimester.
引文
[1]王颖金,安培莉,侯小霞,等.孕11~13+6周产前超声筛查胎儿严重心脏畸形的临床价值.中国优生与遗传杂志,2016,24(12):117-119.
[2]黄晴,练丹,陈静,等.超声软指标对早孕期胎儿心脏结构评估价值分析.中国妇幼保健,2015,30(35):6378-6380.
[3]赵博文.胎儿超声心动图规范化检查指南与解读.浙江医学,2014,34(6):399-404.
[4]刘建新,王贤明,郭少文,等.早孕期胎儿心脏轴线变化及其临床意义.中国医学影像技术,2014,30(1):103-105.
[5]Quarello E,Lafouge A,Fries N,et al.Basic heart examination:Feasibility study of first-trimester systematic simplified fetal echocardiography.Ultrasound Obstet Gynecol,2017,49(2):224-230.
[6]Larry R Cochard.奈特人体胚胎学彩色图谱.高茂英,译.北京:人民卫生出版社,2004:83.
[7]Huhta JC.First-trimester screening for congenital heart disease.Curr Opin Cardiol,2016,31(1):72-77.
[8]任苓,曾庆新,程玲,等.超声筛查早孕期胎儿心脏异常.中国超声医学杂志,2016,32(5):474-476.
[9]Yagel S,Cohen SM,Messing B.First and early second trimester fetal heart screening.Curr Opin Obstet Gynecol,2007,19(2):183-190.
[10]陈萍,常才,徐惠英.早孕期11~14+6周胎儿超声心动图探讨.中华超声影像学杂志,2012,21(5):428-431.
[11]Wiechec M,Knafel A,Nocun A.Prenatal detection of congenital heart defects at the 11-to 13-week scan using a simple color Doppler protocol including the 4-chamber and 3-vessel and trachea views.J Ultrasound Med,2015,34(4):585-594.
[12]Torloni MR,Vedmedovska N,Merialdi M,et al.Safety of ultrasonography in pregnancy:WHO systematic review of the literature and meta-analysis.Ultrasound Obstet Gynecol,2009,33(5):599-608.
[13]Nemescu D,Berescu A,Rotariu C.Variation of safety indices during in the learning curve for color Doppler assessment of the fetal heart at 11+0to 13+6 weeks'gestation.Med Ultrason,2015,17(4):469-474.
[2]黄晴,练丹,陈静,等.超声软指标对早孕期胎儿心脏结构评估价值分析.中国妇幼保健,2015,30(35):6378-6380.
[3]赵博文.胎儿超声心动图规范化检查指南与解读.浙江医学,2014,34(6):399-404.
[4]刘建新,王贤明,郭少文,等.早孕期胎儿心脏轴线变化及其临床意义.中国医学影像技术,2014,30(1):103-105.
[5]Quarello E,Lafouge A,Fries N,et al.Basic heart examination:Feasibility study of first-trimester systematic simplified fetal echocardiography.Ultrasound Obstet Gynecol,2017,49(2):224-230.
[6]Larry R Cochard.奈特人体胚胎学彩色图谱.高茂英,译.北京:人民卫生出版社,2004:83.
[7]Huhta JC.First-trimester screening for congenital heart disease.Curr Opin Cardiol,2016,31(1):72-77.
[8]任苓,曾庆新,程玲,等.超声筛查早孕期胎儿心脏异常.中国超声医学杂志,2016,32(5):474-476.
[9]Yagel S,Cohen SM,Messing B.First and early second trimester fetal heart screening.Curr Opin Obstet Gynecol,2007,19(2):183-190.
[10]陈萍,常才,徐惠英.早孕期11~14+6周胎儿超声心动图探讨.中华超声影像学杂志,2012,21(5):428-431.
[11]Wiechec M,Knafel A,Nocun A.Prenatal detection of congenital heart defects at the 11-to 13-week scan using a simple color Doppler protocol including the 4-chamber and 3-vessel and trachea views.J Ultrasound Med,2015,34(4):585-594.
[12]Torloni MR,Vedmedovska N,Merialdi M,et al.Safety of ultrasonography in pregnancy:WHO systematic review of the literature and meta-analysis.Ultrasound Obstet Gynecol,2009,33(5):599-608.
[13]Nemescu D,Berescu A,Rotariu C.Variation of safety indices during in the learning curve for color Doppler assessment of the fetal heart at 11+0to 13+6 weeks'gestation.Med Ultrason,2015,17(4):469-474.