产前超声在诊断胎儿完全性肺静脉异位引流中的应用
|
摘要
目的探讨胎儿完全性肺静脉异位引流(TAPVC)的超声诊断特征,提高产前诊断率。方法回顾性分析2013年5月至2016年12月于无锡市妇幼保健院产前超声心动图检查中发现并部分经产后超声心动图或引产后尸检随访证实的12例TAPVC胎儿的声像图特点及临床指导意义。结果超声诊断11例TAPVC胎儿中,心上型5例,心下型2例,心内型3例,混合型1例。产前超声漏诊1例,产后诊断为心内型TAPVC。4例为单纯性TAPVC,8例合并复杂性先心病或心外其他畸形。典型二维超声表现为:胎儿四腔心观右房稍大于左房,左房后壁光滑,无肺静脉开口,左房与降主动脉间距离增大,于左房后方见共同肺静脉干,追踪共同肺静脉干走形可显示垂直静脉及引流途径。结论胎儿超声心动图可诊断TAPVC,提示引流途径梗阻情况,为产前咨询及产后处理提供积极的指导作用。
Objective To discuss the characteristics of echocardiographic in fetuses with total anomalous pulmonary venous connection(TAPVC),and to improve the accuracy of prenatal diagnosis.Methods The echocardiographic features and clinical value of 12 fetuses with TAPVC,which were found in prenatal ultrasound examination in our hospital from May 2013 to December 2016 and confirmed by the follow-up results of postnatal echocardiography or postpartum autopsy,were retrospectively reviewed.Results In the group of 11 cases of TAPVC diagnosed by prenatal ultrasound,5 cases were supracardiac type,2 cases were infracardiac type,3 cases were intracardiac type,1 case was mixed type(including supracardiac type and infracardiac type).1 case was missed diagnosis in utero and then provedintracardiac type by postnatal echocardiography.4 cases were isolated TAPVC,8 cases were associated with complex congenital heart disease or other extracardiac malformations.The typical characteristic images of 11 fetuses with TAPVC included the right atrium was slightly larger than the left atrium in apical four-chamber view,the posterior wall of left atrium(LA) was smooth,without ostial of pulmonary vein,the left atrium–descending aorta distance(LD) increased,pulmonary venous(PV) confluence was formed behind the LA,the vertical vein and drainage pathcould be detected by following the tracks of PV confluence.Conclusion Prenatal echocardiography can be used to diagnose fetal TAPVC,reveal the obstruction of blood flow of drainage,give advise to prenatal consultation and postpartum management.
Objective To discuss the characteristics of echocardiographic in fetuses with total anomalous pulmonary venous connection(TAPVC),and to improve the accuracy of prenatal diagnosis.Methods The echocardiographic features and clinical value of 12 fetuses with TAPVC,which were found in prenatal ultrasound examination in our hospital from May 2013 to December 2016 and confirmed by the follow-up results of postnatal echocardiography or postpartum autopsy,were retrospectively reviewed.Results In the group of 11 cases of TAPVC diagnosed by prenatal ultrasound,5 cases were supracardiac type,2 cases were infracardiac type,3 cases were intracardiac type,1 case was mixed type(including supracardiac type and infracardiac type).1 case was missed diagnosis in utero and then provedintracardiac type by postnatal echocardiography.4 cases were isolated TAPVC,8 cases were associated with complex congenital heart disease or other extracardiac malformations.The typical characteristic images of 11 fetuses with TAPVC included the right atrium was slightly larger than the left atrium in apical four-chamber view,the posterior wall of left atrium(LA) was smooth,without ostial of pulmonary vein,the left atrium–descending aorta distance(LD) increased,pulmonary venous(PV) confluence was formed behind the LA,the vertical vein and drainage pathcould be detected by following the tracks of PV confluence.Conclusion Prenatal echocardiography can be used to diagnose fetal TAPVC,reveal the obstruction of blood flow of drainage,give advise to prenatal consultation and postpartum management.
引文
[1] 邓学东.产前超声诊断与鉴别诊断[M].北京:人民军医出版社,2013:122-124.
[2] 王新房.超声心动图学[M].4 版.北京:人民卫生出版社,2009:593-600.
[3] 张颖,王彧.胎儿右房增大原因超声诊断研究[J].中国实用妇科与产科杂志,2016,32(6):564-567.
[4] CHAOUI R,LENZ F,HELING KS.Doppler examination of the fetal pulmonary venous circulation.In:Maulik D,eds.Doppler ultrasound in obstetrics and gynecology[M].Heidelberg:Springer Verlag,2003:451-463.
[5] ANITA SADEGHPOUR,AZIN ALIZADEHASL.Total Anomalous Pulmonary Venous Connection (TAPVC)[M].Springer London,2014:189-192.
[6] 朱清於.先天性心脏病病理解剖学[M].北京:人民军医出版社,2001:87-94.
[7] 苏晓婷,王志斌,陈涛涛,等.超声心动图诊断胎儿完全型肺静脉异位引流[J].中国医学影像技术,2015,31(9):1374-1378.
[8] 潘琦,邓学东,张俊,等.胎儿超声心动图在产前诊断完全型肺静脉异位引流中的应用[J/CD].中华医学超声杂志( 电子版),2013,10(10):836-841.DOI:10.3877/cma.j.issn.1672-6448.2013.10.011.
[9] KAWAZU Y,INAMURA N,SHIONO N,et al.'Post-LA space index' as a potential novel marker for the prenatal diagnosis of isolated total anomalous pulmonary venous connection[J].Ultrasound Obstet Gynecol,2014,44(6):682-687.
[10] PADALINO MA,CAVALLI G,DE FRANCESCHI M,et al.Surgical outcomes of total anomalous pulmonary venous connection repair:a 22-year experience[J].J Card Surg,2014,29(5):678-685.
[11] KRABILL KA,LUCAS RV.Abnormal pulmonary venous connections.In:Emmanouilides GC,Riemenschneider TA,Allen HD,Gutgesell HP,eds.Mass and Adams'Heart disease in infants,children and adolescents[M].5th ed Baltimore:Williams and Wilkins,1995:839-874.
[12] 谢红宁,彭软,杜柳,等.三维超声时间-空间复合成像技术诊断胎儿肺静脉异位引流的价值[J].中国超声医学杂志,2012,(5):465-469.
[2] 王新房.超声心动图学[M].4 版.北京:人民卫生出版社,2009:593-600.
[3] 张颖,王彧.胎儿右房增大原因超声诊断研究[J].中国实用妇科与产科杂志,2016,32(6):564-567.
[4] CHAOUI R,LENZ F,HELING KS.Doppler examination of the fetal pulmonary venous circulation.In:Maulik D,eds.Doppler ultrasound in obstetrics and gynecology[M].Heidelberg:Springer Verlag,2003:451-463.
[5] ANITA SADEGHPOUR,AZIN ALIZADEHASL.Total Anomalous Pulmonary Venous Connection (TAPVC)[M].Springer London,2014:189-192.
[6] 朱清於.先天性心脏病病理解剖学[M].北京:人民军医出版社,2001:87-94.
[7] 苏晓婷,王志斌,陈涛涛,等.超声心动图诊断胎儿完全型肺静脉异位引流[J].中国医学影像技术,2015,31(9):1374-1378.
[8] 潘琦,邓学东,张俊,等.胎儿超声心动图在产前诊断完全型肺静脉异位引流中的应用[J/CD].中华医学超声杂志( 电子版),2013,10(10):836-841.DOI:10.3877/cma.j.issn.1672-6448.2013.10.011.
[9] KAWAZU Y,INAMURA N,SHIONO N,et al.'Post-LA space index' as a potential novel marker for the prenatal diagnosis of isolated total anomalous pulmonary venous connection[J].Ultrasound Obstet Gynecol,2014,44(6):682-687.
[10] PADALINO MA,CAVALLI G,DE FRANCESCHI M,et al.Surgical outcomes of total anomalous pulmonary venous connection repair:a 22-year experience[J].J Card Surg,2014,29(5):678-685.
[11] KRABILL KA,LUCAS RV.Abnormal pulmonary venous connections.In:Emmanouilides GC,Riemenschneider TA,Allen HD,Gutgesell HP,eds.Mass and Adams'Heart disease in infants,children and adolescents[M].5th ed Baltimore:Williams and Wilkins,1995:839-874.
[12] 谢红宁,彭软,杜柳,等.三维超声时间-空间复合成像技术诊断胎儿肺静脉异位引流的价值[J].中国超声医学杂志,2012,(5):465-469.