单纯性完全型肺静脉异位引流产前8例超声心动图诊断

发布时间：2018-02-27 05:04

本文关键词： 完全型肺静脉异位引流胎儿超声心动图产前诊断　出处：《中国循证儿科杂志》2015年02期 　论文类型：期刊论文

【摘要】：目的探讨胎儿单纯性完全型肺静脉异位引流(TAPVC)的产前超声心动图特点,提高对本病的产前诊断准确率。方法回顾性分析2011年5月至2014年2月经新生儿超声心动图、手术或尸解证实的8例单纯性TAPVC的胎儿期超声心动图检查结果,总结超声心动图特征。结果 8例单纯性TAPVC胎儿中,心下型2例,心内型1例,心上型5例,5例存在垂直静脉或共同肺静脉腔与垂直静脉连接处梗阻;8例胎儿中,引产1例(心下型),余7例均于出生后行手术治疗,其中1例术后死亡(心下型),6例均恢复良好。TAPVC胎儿超声心动图特征为:1正常的左心房形态消失,呈圆形或椭圆形,左心房光滑并多变小,在孕后期较为明显;2降主动脉与左心房间距离明显增大,多数在左心房后方可见一异常的腔隙(即共同肺静脉腔),可显示左、右侧上升(心上型)或下降(心下型)的垂直静脉;3妊娠早期左、右心系统比值早期多正常,但妊娠中、晚期(孕26周后)可出现右心系统轻度扩大;4引流入冠状静脉窦时(心内型),冠状静脉窦可有扩张;引流入上腔静脉时(心上型),上腔静脉扩张;引流入肝内血管时(心下型),肝内血管可有不同程度的扩张;5彩色多普勒可显示引流途径及是否合并垂直静脉梗阻。结论在孕早期左、右心系统比值正常时,TAPVC易被漏诊及误诊,应注意多角度、多切面扫查,孕晚期超声心动图检查可减少漏诊。
[Abstract]:Objective to investigate the prenatal echocardiographic characteristics of fetal simple complete pulmonary venous ectopic drainage (TAPVC) and to improve the accuracy of prenatal diagnosis. Methods the neonatal echocardiography from May 2011 to 2014 was retrospectively analyzed. The results of fetal echocardiography in 8 cases of simple TAPVC confirmed by operation or autopsy were summarized. Results in 8 cases of simple TAPVC fetus, 2 cases were subcardiac type, 1 case was intracardiac type, 2 cases were subcardiac type, 1 case was intracardiac type, 2 cases were simple TAPVC fetus, 2 cases were subcardiac type, 1 case was intracardiac type. In 5 cases of supracardiac type, 5 cases had obstruction of vertical vein or common pulmonary vein cavity and vertical vein connection in 8 fetuses, 1 case was induced labor (subcardiac type, 7 cases were treated by operation after birth). One case died after operation (6 cases of subcardiac type) recovered well. TAPVC fetal echocardiography showed that the normal left atrium disappeared with circular or elliptical shape, and the left atrium was smooth and variable. The distance between descending aorta and left atrium was obviously increased in the later stage of pregnancy. An abnormal space (common pulmonary venous cavity) could be seen in most cases after the left atrium. The ratio of the right ascending (supracardiac) or descending vertical vein (subcardiac type) to the left and right cardiac system in early pregnancy was normal, but in pregnancy, the ratio of right and left cardiac system was normal in early pregnancy. In the late stage (after 26 weeks of pregnancy), the right cardiac system may be slightly enlarged and introduced into the coronary sinus (Intracardiac type, coronary sinus dilatation, superior vena cava, superior vena cava). When drainage into intrahepatic vessels (subcardiac type, intrahepatic vessels can be dilated to varying degrees by color Doppler flow imaging), the drainage pathway and the presence of vertical venous obstruction can be demonstrated. Conclusion TAPVC is easy to be missed and misdiagnosed in early pregnancy when the ratio of left and right heart system is normal. Attention should be paid to multi-angle, multi-section scan, echocardiography in late pregnancy can reduce missed diagnosis.
【作者单位】：首都医科大学附属北京安贞医院儿童心血管病中心;
【分类号】：R540.45;R714.5

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