超声检查肺门部大血管横切面预测胎儿心脏锥干系统疾病的价值

目的探讨超声检查肺门部大血管横切面在预测胎儿心脏锥干系统疾病中的价值。方法 28例经我院产前超声心动图诊断为锥干系统疾病的胎儿,分析其肺门部大血管横切面的超声表现。结果 28例锥干系统疾病胎儿(完全型大动脉转位5例,矫正型大动脉转位2例,法洛氏四联症7例,法洛氏四联症合并肺动脉瓣缺如1例,永存动脉干5例,右室双出口8例),肺门部大血管横切面声像图表现异常24例,包括血管数目、血管排列、位置关系及血管内径异常。结论肺门部大血管横切面的应用对于胎儿锥干系统疾病的产前诊断和预后评估有重要意义。     

胎儿主动脉瓣二瓣化畸形的超声特征分析

目的探讨胎儿主动脉瓣二瓣化畸形超声心动图特征。方法回顾性分析12例经产后证实的主动脉瓣二瓣化畸形胎儿超声心动图资料。结果 12例主动脉瓣二瓣化畸形胎儿,8例产前明确诊断,3例产前有阳性超声表现提示,1例漏诊。主动脉瓣二瓣化畸形胎儿超声心动图特征性表现:(1)升主动脉增宽(9例,75%);(2)左室流出道切面主动脉瓣开放不贴壁(8例,67%);(3)心底大动脉短轴切面主动脉瓣显示2个瓣(8例,67%)。4例合并主动脉瓣狭窄,3例产前明确诊断,瓣口峰值流速≥1.4m/s,1例产前未提示;另有3例产前考虑合并主动脉瓣狭窄,产后证实不合并狭窄,瓣口峰值流速均1.4m/s。结论升主动脉增宽为胎儿主动脉瓣二瓣化畸形超声心动图中最敏感征象,左室流出道切面主动脉瓣开放不贴壁为第二间接征象,心底大动脉短轴切面清晰显示主动脉瓣2个瓣是其确诊指征。产前瓣口峰值流速≥1.4m/s,为诊断是否合并狭窄的敏感指征。     

超声心动图对正常胎儿卵圆孔、卵圆孔瓣的定量研究

卵圆孔(foramen ovale)是胎儿时期一个重要的血流通道,卵圆孔瓣覆盖于其上,起到活瓣的作用.目前国内、外学者对超声测量正常胎儿卵圆孔大小、卵圆孔血流速度的研究较多,但是对卵圆孔瓣长度、开放高度及相关比值的研究较少.本研究旨在对超声测量正常胎儿卵圆孔及卵圆孔瓣进行系统研究,建立卵圆孔及卵圆孔瓣的超声测值及相关比值的正常范围,并分析其临床意义.     

三维超声估测左心室舒张末期容积指数对法洛四联症手术的指导价值

目的 探讨三维超声(3DE)估测左心室舒张末期容积指数(LVEDVI)对法洛四联症(TOF)根治手术预后的指导价值.方法 采用传统的M型和二维心尖四腔观单平面、双平面Simpson法与3DE测量方法分别估测38例TOF患者的LVEDVI并进行差异性研究.以经验值LVEDVI＜24 ml/m2及LVEDVI＜20 ml/m2为手术禁忌,对四种方法预测手术禁忌病例的敏感性及特异性进行统计学比较.结果 传统的M型法、单平面Simpson法LVEDVI测值与3DE测值差异均有统计学意义(P＜0.05),双平面Simpson法LVEDVI测值与3DE测值差异无统计学意义.以两种经验值为禁忌分组预测因左室容积过小引起严重的低心排血量综合征导致死亡病例的敏感性及特异性结果:M型法预测的敏感性最低,与其他测量法差异无统计学意义(P＞0.05);单平面Simpson法预测的特异性最低,与其他三种方法比较差异有统计学意义(P＜0.05).结论 3DE估测法可为判断法洛四联症根治手术预后提供可靠依据.     

胎儿动脉导管的超声检测

目的 探讨超声检测胎儿动脉导管的方法学.方法 以胎儿四腔心观为基准,移动探头显示由动脉导管及其相邻结构形成的"V"形征、三指征、"Z"形征、"曲棍柄"征等特征性的超声图像,在形成"V"形征的切面测量动脉导管的内径、收缩期流速、舒张期流速和阻力指数.结果 动脉导管内径随着胎儿孕周的增长逐渐增宽,流速逐渐加快,阻力指数随孕周增加无明显变化.结论 根据"V"形征、三指征、"Z"形征、"曲棍柄"征等特征性声像图可以快速辨认胎儿动脉导管.

Abstract：

Objective To explor the ultrasonography methodology of the fetal ductus arteriosus.Methods Based on the fetal four-chamber sight, the characteristic ultrasound images were observed by moving probe,such as "V-shape" sign,"three-finger" sign,"Z-shape" sign and"hockey-handle" sign making up of the ductus arteriosus and the nearby structures were observed by moving probe. The inner diameter,the systole flow velocity,the diastole flow velocity and the resistance index of the ductus arteriosus via the "V-shape" sign section were measured. Results Among the 365 normal fetus cases,355 "V-shape" sign cases,237 "three-finger" sign cases,298 "Z-shape" sign cases and 331 "hockey-handle" sign cases were identified. The inner diameter of the fetal ductus arteriosus increases gradually with the growth of the gestational weeks and the flow velocity increases gradually too, while the resistance index had no obvious variation with the growth of the gestational weeks. Conclusions According to the characteristic ultrasound images, such as "V-shape" sign, "three-finger" sign, "Z-shape" sign and "hockey-handle" sign, the fetal ductus arteriosus can be identified promptly.     

胎儿与儿童法洛四联症超声心动图特征对比

本研究对产前诊断的11例胎儿法洛四联症(TOF)的超声心动图特征进行总结性分析并与儿童TOF超声心动图特征进行对比分析,探讨TOF胎儿期与儿童期超声心动图特征的不同点,提高产前诊断率.     

超声心动图评价动脉导管对胎儿先天性心脏病的诊断价值

目的 探讨超声心动图评价动脉导管在胎儿先天性心脏病中的诊断价值.方法 以三节段诊断法进行胎儿超声心动图检查,依胎位不同在不同切面检查动脉导管,切面包括动脉导管与右肺动脉形成的"V"形征切面,动脉导管与主动脉弓峡部形成的"V"形征切面,动脉导管与左、右肺动脉形成的"三指征"切面,左肺动脉、动脉导管、主动脉弓峡部形成的"Z"形征切面,测量动脉导管的内径及流速.结果 检出先天性心脏病胎儿31例,13例经尸体解剖得到证实,其中动脉导管狭窄者4例,均为右心梗阻性疾病;动脉导管增宽3例,均为左心梗阻性疾病;动脉导管内测及反向血流者2例;动脉导管流速增高者5例,其中包括4例右心梗阻性疾病、1例左心梗阻性疾病,5例胎儿动脉导管未见异常;1例胎儿动脉导管缺如.结论 超声心动图评价动脉导管是筛查胎儿先天性心脏病的重要内容,有助于快速确定诊断.

Abstract：

Objective To explore the value of ductus arteriosus in ultrasound diagnosis of fetal congenital heart disease by echocardiography. Methods The fetal echocardiography was performed with three segments diagnosis method. According to the fetal position, the ductus arteriosus was examined in different sections which include the "V" shape sign section formed by ductus arteriosus and right pulmonary artery,the "V" shape sign section formed by ductus arteriosus and the gorge of aortic arch,the three fingers sign section formed by ductus arteriosus,left and right pulmonary artery,the "Z" shape sign section formed by left pulmonary artery, ductus arteriosus and the gorge of aortic arch. The flow velocity and the inner diameter of the ductus arteriosus were measured. Results Thirty-one cases with congenital heart disease were evaluted. Thirteen cases were approved by autopsy. Among those fetus, 4 cases went with ductus arteriosus stenosis and they all accompanied with right heart obstructing disease,3 cases went with dilated ductus arteriosus and they all accompanied with left heart obstructing disease. Retrograde were explored in 2 fetus. The flow velocity of 5 fetus ductus arteriosus were higher than the normal fetus and 4 cases of them with right heart obstruction, 1 cases with left heart obstruction. Five fetal ductus arteriosus were normal. One fetal ductus arteriosus was absent. Conclusions Assessant of ductus arteriosus by echocardiography is an important content in screening fetal congenital heart disease. It can help us to diagnose quickly.     

肺静脉血流频谱改变对胎儿心脏异常的诊断价值

目的 探讨肺静脉血流频谱改变对胎儿心脏异常的诊断价值.方法 对206例胎龄为22～38周的胎儿行心脏超声检查,根据胎儿心脏是否正常分为正常组146例和异常组60例,异常组中包括心律失常8例和心脏结构异常52例.检测两组肺静脉血流相关参数:S波(收缩期峰值速度)、D波(舒张期峰值速度)、A波(心房收缩期峰值速度),计算S/D、S/A、(S-A) /D(静脉峰值速度指数),比较两组间上述参数,以上参数与胎龄行线性相关性分析.结果 52例心脏结构异常胎儿中,5例肺静脉频谱A波缺失,9例A波反向;8例房性早搏肺静脉频谱中A波提前出现,打乱正常的A-A间期,A波之后可见一高大的S波.正常组与心脏结构异常组中A波正向病例比较:(S-A) /D差异有统计学意义(P＜0.05),其余参数差异无统计学意义(P＞0.05).(S-A) /D与孕周相关系数为-0.156,P-0.061.结论 肺静脉血流参数可作为评价胎儿心脏异常的一项指标.     

超声检查对正常胎儿主动脉弓演变规律的探讨

目的 探讨正常胎儿主动脉弓的发育演变规律,提高主动脉弓异常的产前超声检出率.方法 在主动脉弓长轴切面,将主动脉弓分为3段进行观测:左锁骨下动脉与动脉导管之间命名为A段(峡部),左颈总动脉与左锁骨下动脉之间命名为B段,无名动脉与左颈总动脉之间命名为C段,测量A、B、C段和升主动脉(AAO)、无名动脉(INA)、左颈总动脉(LCCA)、左锁骨下动脉(LSA)、降主动脉(DAO)的内径,测量A段血流速度.结果 正常胎儿主动脉弓及其分支内径随孕周增大而增宽,A/AAO、B/AAO、C/AAO、A/DAO、A/LSA、B/LCCA、C/INA内径比随孕周增长逐渐降低.主动脉弓峡部血流速度高于升主动脉并随孕周增长而加快,本组胎儿最高值为1.07 m/s,阻力指数未见明显变化,平均0.84±0.04.结论 超声检查对认识正常胎儿主动脉弓发育演变的规律,观测主动脉弓各段的内径及其与相邻动脉内径的比值对主动脉弓缩窄的产前诊断有重要价值.     

三维超声心动图对Chiari网的诊断价值

Chiari网是位于右心房中的网状或条索状的胚胎残存结构[1],系胚胎发育过程中吸收不完全的下腔静脉瓣和冠状窦瓣退化形成。Chiari网是一种先天发育变异,与血栓栓塞性疾病、心内膜炎、心律失常、介入检查治疗中缠绕导管导致进退困难等有关[1-5],逐渐受到临床医师的重视。然而,由于经验认识不足及视野的局限性,二维超声心动图(twodimensional echocardiography,2DE)对此类疾病的诊断分类