胎儿先天性心脏病和心律失常的诊断及干预

目的 研究胎儿超声心动图产前诊断先天性心脏病（简称先心病）和经胎盘治疗胎儿心律失常的价值。方法 应用国产FECG－D型胎儿心电图仪筛查，结合胎儿超声心动图检测第1胎患先心病的460例胎龄为18－40周的高危胎儿，超声仪采用ALT、Maker LX和TOSHBA SSA 40A多普勒彩色超声仪，探头频率为3．5MHz。结果 发现先心病8例，同胞一级亲属患病率为1．7％。先心病的类型：房间隔缺损（简称房缺）3例（其中1例合并胎儿水肿），室间隔缺损（简称室缺）13例（其中1例合并神经管缺损），完全性的房室管缺损1例，法洛四联症1例。检出23例胎儿心律失常，检出率为5．0％，以室上性心动过速（简称室上速）最多见（13例），首选地高辛经胎盘治疗，7例有效，其中3例合并先心病或心力衰竭者加用异博定2例有效，1例因有严重的非免疫性胎儿水肿而死亡；3例窦性心运过速（简称窦速）患儿用心得安治疗有效，1例频发室性早博用普鲁卡因酰胺治疗后转复。3例妊娠晚期的室上速和2例室上性早博未用药，经阴道分娩后转复。结论 胎儿超声心动图是产前诊断胎儿心脏异常的重要手段，地高辛是经胎盘治疗胎儿快速心律失常的首选药物。

Diagnosis and intervention of fetal congenital heart diseases and arrhythmias

Objective To estimare and determine the values in prenatal detection of fetal cardiac abnormality and transplacental therapy of fetal arrhythmias. Methods Forty hundreds and sixty high-risk fetuses of 18-40 weeks gestational ages, mothers of whom carried abnormal babies with congenital heart diseases (CHD) in the first pregnancy, were screened and detected with the FECG-D type electrocardiography and Doppler ultrasound echocardiography (ATL Maker IX and TOSHIBA SSA 40A, with the 3.5 MHz transducer).Results Twenty-three of 460 fetuses (5.0%) were found to have arrhythmias. There were 13 cases the supraventricular tachycardia (SVT), 9 of whom were treated with transplacental digoxin and showed excellent responses. Three cases complicated with CHD or the heart failure were also treated with digoxin plus verapamil, and 2 of them were improved and one died. Three cases of sinus tachycardia were effectively treated with propranolol. One case of frequent ventricular premature (VP) beats was cured with the procainamide. Three cases of SVT in the third trimester and two cases of occasional VP were not intervened with drugs and improved after birth. Of 460 high-risk fetuses, the incidence of the first degree relatives was 1.7%. Eight fetuses were detected to have CHD, which included the ASD in 3 cases, VSD in 3 cases, complete AV canal 1 case and TOF 1 case. Conclusion The fetal echocardiography was an essential and cost-effective method for diagnosis of fetal cardiac abnormalities. The transplacental digoxin intervention was the first choice in the treatment of the fetal tachyarrhythmia.