胎儿右心系统扩大的类型及超声诊断思路

目的分析胎儿右心系统扩大的超声特点及类型和原因，探讨其产前超声诊断思路。 方法回顾性选取2013年1月至2017年8月在陕西省胎儿先天性心脏病超声诊断中心行胎儿超声心动图检查并检出右心系统扩大的胎儿685例，对其结果进行分析，总结胎儿右心系统扩大的特点、类型及原因。 结果685例右心系统扩大的胎儿中右心系统绝对扩大515例（515/685，75.18%），包括单纯右心系统扩大和继发性扩大，右心系统继发性扩大的主要原因为各种病变导致的右心系统前后负荷增加；左心系统小导致右心系统相对扩大170例（170/685，24.82%），原因包括单纯左心系统小、左心室发育不良及心外异常。单纯右心系统扩大胎儿胎龄≥28周的所占比例为70.42%（200/284），而单纯左心系统小的胎儿胎龄≥28周的所占比例为51.67%（31/60）。 结论胎儿右心系统扩大可分为绝对扩大和相对扩大2种类型，并以绝对扩大为主，在排除所有可能导致右心系统继发性扩大的明确病变后，可考虑为单纯性扩大，胎儿右心系统扩大的预后评估需根据不同结构病变的具体情况进行综合分析。

Right heart system enlargement in fetuses: type and strategy for ultrasonic diagnosis

ObjectiveTo explore the strategy for prenatal ultrasonic diagnosis of right heart system enlargement in fetuses by analyzing its ultrasonic characteristics and causes. MethodsThe data of 685 fetuses with enlarged right heart system diagnosed by fetal echocardiography from January 2013 to August 2017 at Shaanxi Province Centre for the Ultrasound Diagnosis of Fetal Congenital Heart Diseases were analyzed. The characteristics, causes, and type of enlarged right heart system were summarized. ResultsFive hundred and fifteen fetuses had absolute enlargement, accounting for 75.18% (515/685) of all cases. There was simple enlargement of right heart system and secondary enlargement. The main reason for the secondary enlargement was the increase of the right heart system load caused by various lesions, including pre-load and post-load. One hundred and seventy (170/685, 24.82%) fetuses had relative enlargement of right heart system, because of small left heart system, including simple enlargement of left heart system, left ventricular dysplasia, and other abnormalities. The proportion of fetuses with enlarged right ventricular system in late pregnancy (gestational age≥28 weeks) was 70.42%, and the proportion of fetuses with small left ventricular system in late pregnancy (gestational age≥28 weeks) was 51.67%. ConclusionThe enlargement of right heart system in fetuses is divided into absolute enlargement and relative enlargement, with the former being the predominant type. After excluding all clear lesions that may cause secondary enlargement of right heart system, simple enlargement with a good prognosis could be considered. The prognostic evaluation of fetal right ventricular system enlargement should be based on the specific situation of different structural changes.