超声心动图诊断胎儿肺动脉狭窄的产前及产后对照分析

目的 探讨胎儿肺动脉狭窄产前及产后超声心动图的变化规律.方法 选择2014年6月至2016年6月我院经超声诊断或怀疑肺动脉狭窄的胎儿16例,出生后进行随访.对照分析胎儿产前及产后肺动脉狭窄超声心动图的声像图特征,探讨胎儿肺动脉狭窄产前及产后血流动力学变化规律,对漏诊和误诊病例进行分析.结果 16例胎儿出生后1个月内进行随访,超声心动图证实13例新生儿存在不同程度的肺动脉狭窄,其中10例为单纯性肺动脉瓣狭窄:重度狭窄者具有典型的声像图特征,均伴有三尖瓣重度反流、右房大、右室小、动脉导管血流反向,预后较差;轻度和中度狭窄者产前超声图像特征不明显而容易漏诊,产后随访其狭窄程度可逐渐减轻,2例进行性加重.3例为肺动脉主干狭窄且伴有心内畸形,产前及产后超声表现一致,预后较差.另有3例产前诊断为肺动脉主干轻度狭窄,出生后超声心动图显示肺动脉正常.结论 胎儿肺动脉狭窄产前和产后血流动力学具有特征性改变,需要对胎儿肺动脉狭窄进行产前及产后超声心动图动态随访,评估其狭窄程度和预后.

Comparison of echocardiographic findings of fetal pulmonary stenosis before and after delivery

Objective To compare the echocardiographic characteristics of fetal pulmonary stenosis before and after delivery.Methods Sixteen fetuses with a confirmed or suspected diagnosis of pulmonary stenosis by echocardiography in our department from June 2014 to June 2016 were analyzed.The sonographic features of pulmonary stenosis in echocardiography and the hemodynamic parameters before and after delivery were compared.The misdiagnosis and missed diagnosis were analyzed in these cases.Results Within 1 month after birth,echocardiography confirmed pulmonary stenosis in 13 newborns,including 10 with uncomplicated pulmonary valve stenosis.The cases with severe pulmonary stenosis showed characteristic echocardiographic features,including severe tricuspid regurgitation,a large right atrium,a small right ventricle,and retrograde blood flow in the arterial duct,which were all associated with a poor prognosis.In cases with mild or moderate pulmonary stenosis,prenatal echocardiography showed no characteristic findings to easily cause missed diagnosis,and follow-up echocardiography may show gradual alleviation of the stenosis,but in 2 cases,the condition could deteriorate progressively.Three cases were confirmed to have pulmonary stenosis with concurrent intracardiac malformation and consistent pre-and postnatal echocardiographic findings,and all these 3 cases had a poor prognosis.In another 3 cases,echocardiography after delivery showed normal pulmonary artery although they were diagnosed to have mild pulmonary stenosis by prenatal echocardiography.Conclusion The hemodynamics of fetal pulmonary artery stenosis can present with characteristic changes in echocardiography after birth,suggesting the need of close and regular echocardiographic follow-up of the fetuses to assess the changes of stenosis and the prognosis.