超声监测筛查胎儿先天性心脏畸形

目的 探讨超声监测筛查胎儿先天性心脏畸形的可行性及临床应用价值。方法 对常规产前超声检查在胎心四腔观中疑有异常，临床发现胎儿心律不齐，以及母体有高危因素共20例行超声心动图检查。以观察胎儿四腔观为基础，酌情增加长轴、短轴、主动脉弓等切面观，并适当配合彩色多普勒及脉冲多普勒超声检查。结果 超声检查发现的20例先天性心脏异常中，17例先天性心脏病，其中1例右位心并完全性内脏转位，1例为单纯性室内隔缺损（生后证实其染色体为21三体），15例复杂性先天性心脏病；3例心脏肿瘤，其中2例为室间隔横纹肌瘤，1例为心室壁横纹肌瘤。20例心脏异常病例中4例同时合并其他器官结构异常，7例右位心及不同程度内脏转位，8例脐动脉A/B值异常，4例心律紊乱。结论 产前超声筛查胎儿先天性心脏畸形切实可行。对有高危因素、胎儿心律失常及其他内脏畸形者，应重点行超声心动图检查。

Prenatal echocardiographic screening for fetal congenital heart malformation

Objective To investigate the possibility of prenatal echocardiographic screening for fetal congenital heart malformation. Methods Twenty cases had detail echocardiography for abnormal four-chamber view found on routine ultrasonography,with fetal cardiac arrhythmia and maternal high risk factors. The main view observed was four-chamber and combined with long axial view, short axial and aortic arch view etc, as well as color Doppler and pulsed Doppler examination.Results Among the 20 cases of congenital heart malformation diagnosed on ultrasonography, 17 cases were congenital heart diseases, one had dextrocardia with complex viscera transposition, another one had ventricular septal defect and found to be trisomy 21 after birth, the rest 15 cases all were complex congenital heart disease. Three cases had intracardiac tumor(Rhabdomyoma) among which the tumor located on ventricular septum in two cases and one case on the left ventricular wall. Among the 20 cases with abnormal heart diseases,4 cases had other organ structure abnormality simultaneously, 7 cases had dextrocardia with different degree of viscera transposition, 8 cases had abnormal umbilical blood flow and 4 cases had fetal cardiac arrhythmia. Conclusions It is really possible that prenatal echocardiographic screening be done for fetal congenital heart malformation. Fetal echocardiography should be done emphatically in high risk pregnancy, fetal cardiac arrhythmia and fetus with other viscera abnormality.