不同切面超声心动图诊断胎儿心脏畸形的临床研究

目的探讨不同切面超声心动图诊断胎儿心脏畸形的价值。方法对1341例孕妇行胎儿超声心动图检查，采用二维、彩色及频谱多普勒从常规取胎儿四腔心、五腔心、左心室流出道及右心室流出道长轴、大动脉短轴、主动脉弓及动脉导管弓长轴等切面观察胎儿心脏解剖结构及血流状况。并与引产后的尸检结果进行对照。结果本组共检出胎儿先天性心脏畸形30例，经引产后胎儿尸体解剖和产后新生儿随访证实与产前完全相符合28例，占93．33％（28／30），有2例复杂性畸形与产前诊断基本相符合，占6．67％（2／30）。在出生后的新生儿中发现2例室间隔缺损，1例房间隔缺损漏诊，漏诊率为9．09％（3／33）。畸形类型包括室间隔缺损3例，房间隔膨胀瘤3例，心内膜垫缺损1例，单心室4例，大动脉转位2例，右室双出口2例，永存动脉干2例，左心室发育不良3例，右心室发育不良2例，三尖瓣闭锁2例，三尖瓣下移畸形2例，肺动脉闭锁1例，严重心律失常3例。产前超声诊断符合率为90．91％（30／33）。结论不同切面超声心动图可用于产前胎儿心脏畸形的诊断。

Clinical study of diagnosis of fetal cardiac malformation from different section of echocardiography

Objective To explore different facets of echocardiography diagnosis of fetal cardiac malformations. Methods 1 341 cases during pregnancy fetal echocardiography, using two-dimensional, color and spectral Doppler from conventional fetal four chamber heart, the five-chamber, left ventricular outflow tract and right ventricular outflow tract long axis, short axis aorta, aortic arch and arteri- al arch axis and other facets of fetal heart anatomy and observation of blood flow. With the induction of labor after the autopsy results were compared. Results There were detected 30 cases of fetal congenital heart disease by fetal autopsy after induced abortion and postpartum and newborn follow - up confirmed 28 cases of prenatal fully compatible, accounting for 93.33 % （28/30）, 2 cases of complex malformations basically consistent with the prenatal diagnosis, accounting for 6.67 % （2/30）. Newborns after birth found two cases of ventrieular septal defected,missed 1 case of atrial septal defected,missed diagnosis rate was 9.09% （3/33）.Deformity types including 3 cases of ventricular septal defect, atrial septal aneurysm expansion in 3 cases, 1 case of endocardial cushion defect, single ventricle in 4 cases, 2 cases of-transposition of great arteries, double outlet right ventricle in 2 cases, 2 cases of persistent truncus arte- riosus, left ventricular 3 cases of dysplasia, right vcntricular dysplasia in 2 cases, 2 cases of tricuspid atresia, Ebstein malformation in 2 cases, 1 case of pulmonary atresia, 3 cases of serious arrhythmia. Diagnosis by prenatal ultrasound was 90.91% （30/33）. Conclusion Different section of echocardiography can be used for prenatal diagnosis of fetal cardiac malformations.