圆锥动脉干畸形产前超声诊断与误诊分析

发布时间：2018-09-04 12:11

【摘要】：目的:探讨产前超声诊断圆锥动脉干畸形的难点及误诊原因分析。方法:对36例胎儿圆锥动脉干畸形的病例资料进行回顾分析,将产前诊断结果与产后新生儿超声心动图或引产后解剖结果进行对比。分析产前诊断结果的偏差,总结产前超声诊断圆锥动脉干畸形的经验。结果:产前超声诊断法洛四联症9例,右室双出口8例,肺动脉闭锁伴室间隔缺损6例,完全型大动脉转位4例,矫正型大动脉转位1例,永存动脉干7例。产前诊断9例法洛四联症中2例产后手术证实为右室双出口,产前漏诊法洛四联症1例,产前诊断符合率70%(7/10);8例右室双出口中2例引产后证实为法洛四联症,产前诊断符合率75%(6/8)。6例产前诊断肺动脉闭锁伴室间隔缺损,1例引产后证实为永存动脉干,产前诊断符合率83.3%(5/6);4例完全型大动脉转位,引产后证实全部正确,产前诊断符合率100%(4/4);1例矫正型大动脉转位产后超声心动图证实正确,产前诊断符合率100%(1/1);产前诊断永存动脉干7例,2例引产后证实为肺动脉闭锁伴室间隔缺损,1例引产后证实为主动脉闭锁伴室间隔缺损,产前诊断符合率57.1%(4/7),产前无法分型2例,产前诊断分型符合率50%(2/4)。结论:产前超声心动图对圆锥动脉干畸形的检出具有重要的价值,产前超声心动图检查中,认真分析动态图回放、掌握CTA血流动力学改变对提高圆锥动脉干畸形产前诊断准确性有重要意义。
[Abstract]:Objective: to investigate the difficulty and misdiagnosis reason of prenatal ultrasound in diagnosing conical artery trunk malformation. Methods: the data of 36 cases of fetal conic artery malformation were analyzed retrospectively. The results of prenatal diagnosis were compared with those of postpartum neonates by echocardiography or anatomic results after induced labor. To analyze the deviation of prenatal diagnosis results and summarize the experience of prenatal ultrasound diagnosis of conical artery trunk malformation. Results: nine cases of tetralogy of Fallot, 8 cases of double outlet of right ventricle, 6 cases of pulmonary atresia with ventricular septal defect, 4 cases of complete transposition of great artery, 1 case of corrected transposition of great artery and 7 cases of persistent artery trunk were diagnosed by prenatal ultrasound. Of the 9 cases of tetralogy of Fallot diagnosed before delivery, 2 cases were confirmed by postpartum operation as double outlet of right ventricle, and 1 case of tetralogy of Fallot was misdiagnosed before delivery. The coincidence rate of prenatal diagnosis was 70% (7 / 10). 2 out of 8 cases of double outlet of right ventricle were confirmed as tetralogy of Fallot after induced labor. The coincidence rate of prenatal diagnosis was 75% (6 / 8) in 6 cases of pulmonary atresia with ventricular septal defect (VSD) in 1 case and proved to be permanent artery trunk in 1 case after induced labor. The coincidence rate of prenatal diagnosis was 83.3% (5 / 6) and 4 cases were transposition of complete great arteries, all of which were confirmed to be correct after induced labor. The accuracy of prenatal diagnosis was 100% (4 / 4). One case of corrected transposition of great arteries was confirmed by postpartum echocardiography. The coincidence rate of prenatal diagnosis was 100% (1 / 1), 7 cases of persistent arterial trunk were confirmed as pulmonary atresia with ventricular septal defect (VSD) in 2 cases after induced labor, and 57.1% (4 / 7) of them were confirmed as aortic atresia with ventricular septal defect (VSD), 2 cases were unable to type before delivery. The coincidence rate of prenatal diagnosis and typing was 50% (2 / 4). Conclusion: prenatal echocardiography plays an important role in the detection of conical trunk malformation. It is important to master the changes of CTA hemodynamics to improve the accuracy of prenatal diagnosis of conical trunk malformation.
【作者单位】：惠州市第一人民医院超声科;中山大学附属第一医院超声科;
【分类号】：R445.1;R714.5

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