纵横四腔心切面偏转法诊断胎儿单纯室间隔缺损的研究

目的探讨纵横四腔心切面偏转法在产前诊断胎儿单纯室间隔缺损（VSD）的临床价值。方法采用四腔心平面头侧偏斜法和纵横四腔心切面偏转法筛查胎儿心脏畸形，在四腔及五腔心切面上利用彩色多普勒重点观察室间隔肌部、膜部有无穿隔血流束；并比较两种方法的准确性、敏感性、特异性。结果四腔心平面头侧偏斜法组单纯VSD24例，检出16例，漏诊8例，敏感性66．67％；纵横四腔心切面偏转法组单纯VSD39例，检出35例，漏诊4例，敏感性89．74％。两种方法诊断胎儿单纯VSD敏感性差异有统计学意义（P〈0．05）。在超声诊断的51例VSD中，二维切面无典型表现仅显示穿隔血流39例，血流束宽小于3mm，占76．47％。结论纵横四腔心切面偏转法不仅能快速地显示胎儿心脏结构及心脏大血管血流情况，而且能很好地显示低速穿隔血流信号，可提高筛查胎儿单纯VSD的敏感性。

The study of fetus simple ventricular septal defects diagnosed by longitudinal and transverse four-chamber view

Objective To explore the clinical value of longitudinal and transverse four - chamber view in diagnosis of fetus simple ventricular septal defects. Methods Fetal heart was screened in four chamber view with probe tilting craniad slightly technique and in longitudinal and transverse four- chamber view. Whether blood flow existed in membranous part or muscular part of interventric- ular septum was observed by color Doppler flow imaging in four- chamber and five- chamber view, then the accuracy, sensitivity and specificity of the two methods were compared. Results Sixteen cases of 24 VSD were detected by four chamber view with probe tilting craniad slightly technique, 8 cases of 24 were missed, the sensitivity was 66.67%, and 35 cases of 39 VSD were detected by longitudinal and transverse four- chamber view, 4 cases of 39 were missed, the sensitivity was 89.74%. There was significant differences be- tween the two methods in detecting fetus VSD（P 〈 0.05）. Fifty- one VSD cases were diagnosed by ultrasound, blood flow was found in 39 cases in two- dimensional sectiones, width of blood flow was less than 3 mm（76.47% ）. Conclusion Longitudinal and transverse four - chamber view can display fetus heart structure and the condition of heart great vessel blood flow clearly, and can also display the low- velocity blood flow of fetal VSD. It can improve sensitivity for detecting fetal simple VSD.