E-Flow血流显像技术对胎儿冠状动脉瘘的诊断价值

目的探讨E-Flow血流显像技术对胎儿冠状动脉瘘的诊断价值。方法在胎儿超声心动图检查中除使用常规彩色多普勒外加用了E-Flow血流显像技术,产前诊断冠状动脉瘘5例。使用Alokaα10彩色超声诊断仪,探头频率为3.5～5.0 MHz。对二维超声(2D)发现胎儿一侧心房、心室异常增大或冠状动脉增粗的患者,进一步探查冠状动脉。先以彩色多普勒超声(CDFI)获取心腔内异常血流,再以连续多普勒(CW)获取舒张期为主的高速血流频谱,初步证实该异常血流来自于冠状动脉。此时启动E-Flow显像模式追溯该异常血流。结果 5例胎儿冠状动脉瘘均出生后经超声证实。其中2例为左冠状动脉右心室瘘、1例为左冠状动脉右心房瘘,1例为右冠状动脉右心房瘘,1例为右冠状动脉右心室瘘。E-Flow显像技术能够敏感地捕捉冠状动脉瘘血流,清晰显示冠状动脉瘘的起源、瘘管的走行以及瘘口的位置、大小,其血流显像优于传统的彩色多普勒。结论应用E-Flow显像技术可以在产前更加准确、快速地诊断胎儿冠状动脉瘘。推荐E-Flow血流显像技术成为胎儿冠状动脉瘘的诊断工具之一。

Values of E-Flow image in prenatal diagnosis of fetal coronary artery fistulas

Objectives To explore the values of eFlow image in prenatal diagnosis of fetal coronary artery fistulas. Methods Five fetuses with coronary artery fistula were prenatally diagnosed using routine fetal echocardiography along with eFlow image. The Aloka oLl0 color Doppler ultrasound apparatus were used with 3.5-5.0 MHz probes. While performing routine fetal echoeardiography, unexplained unilateral enlargement of atrium or ventricle, or extraordinarily large coronary artery were noticed by two-dimensional echocardiography （2DE） in these fetuses,which were followed by careful examination of both coronary arteries and their branches. Firstly, abnormal intracardiac flow was obtained by Color Doppler flow imaging （CDFI）. Then high-speed flow spectrum was obtained using Continuous-wave Doppler （CW） with diastolic predominance, which indicated that the flow originated from the coronary artery. After that, eHow image was initiated to trace the abnormal flow back to its origin. Results Postnatal echocardiography confirmed the prenatal diagnosis in these 5 patients. Left coronary artery-right ventricle fistula was diagnosed in 2, left coronary artery-right atrium fistula in 1, right coronary artery-right atrium fistula in 1, and right coronary artery-right ventricle fistula in 1. EFlow image was sensitive to detect and trace the flow of coronary artery fistula.Origin,lining, position and size of the fistula orifice were clearly demonstrated by this technique, with prior image quality over routine color Doppler techniques. Conclusions EFlow image can be quickly and precisely performed in fetal echocardiography,facilitating the prenatal diagnosis of coronary artery fistula. It should be recommended as one of the diagnostic tools for fetal coronary artery fistula.