母体抗SSA/SSB抗体阳性胎儿完全性房室传导阻滞超声表现

目的 观察母体抗SSA/SSB抗体阳性胎儿完全性房室传导阻滞（CAVB）超声表现。方法 以二维、M型及多普勒超声技术观察7胎母体抗SSA/SSB抗体阳性CAVB胎儿心脏，获取二尖瓣、左心室流入道及流出道、脐动脉（UA）、静脉导管（DV）及大脑中动脉（MCA）血流频谱。结果 7名孕妇抗SSA抗体、抗Ro52抗体均呈阳性，其中4名抗SSB抗体呈阳性。7胎均见房室分离，心房律正常而心室律缓慢，二尖瓣、UA、DV及MCA血流异常；其中4胎心房壁、房间隔、二尖瓣环或腱索回声增强。7胎均未合并其他心内外结构畸形。结论 母体抗SSA/SSB抗体阳性可致胎儿发生CAVB；超声观察胎儿心脏及血流动力学变化有利于判断胎儿预后。

Ultrasonic manifestations of complete atrioventricular block in fetuses with positive maternal anti-SSA/SSB antibodies

Objective To observe the ultrasonic manifestations of complete atrioventricular block (CAVB) in fetuses with positive maternal anti-SSA/SSB antibodies. Methods Seven CAVB fetuses with positive maternal anti-SSA/SSB antibodies were enrolled. Two dimensional, M-type and Doppler ultrasonography were used to observe the fetal ultrasonic manifestations, and the blood flow spectrums of the mitral valve, left ventricular inflow and outflow tract, umbilical artery (UA), venous catheter (DV) and middle cerebral artery (MCA) were obtained. Results All 7 pregnant women were positive for anti-SSA and anti-Ro52 antibodies, and 4 of them were positive for anti-SSB antibody. Ultrasound showed enhanced echoes in atrial wall, interatrial septum, mitral annulus or chordae tendineae in 4 fetuses. All 7 fetuses had atrioventricular dissociation, with normal atrial rhythms, slow ventricular rhythms and abnormal blood flow of mitral valve, UA, DV and MCA. No other internal and external cardiac malformations was detected in 7 fetuses. Conclusion Positive maternal anti-SSA/SSB antibodies could lead to fetal CAVB. Detecting the changes of fetal heart and hemodynamics by ultrasound was helpful to evaluation on prognosis of fetus.