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1.
目的:探讨频谱多普勒及M-型超声心动图对胎儿心律失常的诊断价值。方法:采用彩色多普勒超声心动图对孕龄16~41周的临床疑诊胎儿心律失常或存在其他异常的226例胎儿进行研究。结果:共检出胎儿心律失常53例(23.5%),其中期前收缩40例(房性期前收缩35例,室性期前收缩5例包括室性早搏二联律、室性早搏三联律各1例)。心动过缓7例,心动过速4例,2:1房室传导阻滞、房扑各1例。53例心律失常胎儿中并发先天性心血管畸形4例(二尖瓣闭锁1例,共同房室通道1例,单心室伴肺动脉瓣狭窄1例,心脏肿瘤1例)。结论:胎儿频谱多普勒及M-型超声心动图是检出胎儿心律失常的可靠的无创性影像诊断技术,其应用有助于早期检出并指导心律失常胎儿的处置。  相似文献   

2.
目的 应用组织多普勒成像(TDI)结合传统超声综合评价心脏内强回声结构(ICEF)胎儿的心功能.方法 应用TDI技术的脉冲方式观察ICEF胎儿房室瓣环运动,测量其舒张早期、舒张晚期及收缩期运动的峰值速度(Em、Am、Sm);并结合传统二维、M型及脉冲多普勒超声测量胎儿心脏大小及血流速度系列参数;对照组房室瓣口血流参数与房室瓣环运动参数进行相关分析;两组间评价心脏收缩及舒张功能参数进行独立样本t检验;两组间Em/Am随孕周的变化进行直线回归分析.结果 研究组房室瓣E/A及Em/Am显著低于对照组,并与孕周呈直线关系;对照组E与Em、A与Am、E/A与Em/Am、左室缩短分数与Sm之间呈正相关;两组评价心脏大小各参数之间、心脏收缩功能参数及不同孕期Sm比较差异无统计学意义.结论 TDI可更为敏感、准确地评价胎儿心脏功能;中晚孕期ICEF胎儿心脏舒张功能下降.  相似文献   

3.
Recognition of fetal arrhythmias by echocardiography   总被引:1,自引:0,他引:1  
Fetal arrhythmias were detected in 33/198 high risk pregnancies from 21 weeks to term. Using the two-dimensional echocardiographic image of the fetal heart as a guide, the M-mode beam was directed to define the motion of the ventricular and atrial walls and atrioventricular valve or semilunar valves. Atrial contraction was defined either by the atrial wall motion or from the A-point of the atrioventricular valve. Ventricular contraction was defined by closure of the atrioventricular valve (C-point), the onset of ventricular wall contraction, or from the semilunar valve opening. Ladder diagrams of the sequence of atrial and ventricular activation were constructed to define the temporal sequence of these events. Premature atrial contractions were present in 12. In one fetus this arrhythmia converted into supraventricular tachycardia while in the other 11 fetuses the course was benign. Two fetuses had premature ventricular contractions. Supraventricular tachycardia was noted in five fetuses. One with hydrops at 29 weeks returned to sinus rhythm following maternal administration of procainamide. A second hydropic fetus with paroxysmal atrial tachycardia and hydrops failed to respond to digitalis, propranolol, procainamide, verapamil, or amiodarone, and died shortly after cesarean section. Two mature fetuses had tachycardia close to term and were treated after cesarean section. One fetus with runs of atrial tachycardia died in utero. Three fetuses had complete heart block, two of whom were from mothers with connective tissue diseases. In four fetuses, there was bradycardia of less than 100/minute lasting more than 30 seconds, but these episodes disappeared in 2 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

4.
胎儿超声心动图检测胎儿房性期前收缩的临床研究   总被引:1,自引:0,他引:1  
目的:探讨胎儿超声心动图对胎儿房性期前收缩观察价值及其临床意义。方法:采用彩色多普勒超声心动图对404例孕龄16~42周(平均32.5周)的胎儿进行研究.分析胎儿房性期前收缩的超声心动图特征及其检出率。结果:共检出胎儿房性期前收缩41例,检出率为10.1%。其中下传33例,不下传5例.部分下传3例。41例胎儿均不伴有先天性心血管畸形或其它畸形,出生后听诊均未闻及明显心脏杂音或心律不齐。结论:胎儿房性期前收缩为胎儿期最常见的心律失常,不伴有明显心血管畸形或其它胎儿畸形,绝大多数预后良好。  相似文献   

5.
目的 观察孕11~13+6周心脏畸形胎儿四腔心切面声像图特征,探讨其在早孕期筛查中的价值。方法 回顾性分析24胎经病理、中孕期胎儿超声心动图检查或出生后随访证实的11~13+6周心脏复杂畸形胎儿心脏四腔心切面超声声像图特征和颈项透明层(NT)厚度。结果 24胎心脏畸形胎儿早孕期四腔心切面表现:①6胎正常,可见2束比例相当的心室流入道血流;②3胎表现为比例失调的2束血流;③5胎仅显示1束房室瓣血流,于心室水平再分为左右2束血流;④5胎显示1束房室瓣血流,于心室水平无分叉;⑤5胎表现为室间隔过隔血流。24胎中,16胎(16/24,66.67%)NT增厚,8胎(8/24,33.33%)NT正常。结论 11~13+6周四腔心切面超声表现对筛查胎儿心脏畸形具有一定价值,有望将部分心脏畸形的检查时间窗由中孕期提前至早孕期。  相似文献   

6.
正常胎儿彩色多普勒超声心动图分析   总被引:2,自引:0,他引:2  
目的获得正常胎儿心脏彩色多普勒超声心动图的各种参数。方法应用彩色多普勒超声诊断仪,对胎龄20~40周300例正常胎儿的四腔室内径和各瓣口峰值血流速度进行了检测。结果胎儿心脏内径的大小与胎龄呈正相关,右心系统占优势。各瓣口峰值血流速度随胎龄的增加而升高,左室低于右室;房室瓣口呈双峰型频谱,E峰小于A峰,而主、肺动脉瓣口呈单峰型频谱伴峰值前移,主动脉瓣口血流高于肺动脉。结论彩色多普勒超声心动图对于胎儿心脏的解剖结构和血流动力学检测具有很高的价值。  相似文献   

7.
We hypothesized that in chronic fetal anemia, remodeling of the myocardium is related to abnormalities in regional wall motion and acutely increased afterload further disturbs myocardial strain. Chronic anemia was induced in one fetus of each of seven sheep twin pregnancies. The fetuses were studied by two-dimensional (2-D) strain echocardiography at baseline and during increased afterload via angiotensin II (AT II) infusion. At baseline, the peak systolic longitudinal, radial and circumferential strains in the left ventricular lateral wall in anemic fetuses were lower than those in the controls (all p<0.05). During AT II, the circumferential strain of right ventricular free wall decreased significantly both in the control and anemic fetuses. Left ventricular free wall systolic strains were not affected by AT II. Fetal myocardial remodeling in chronic anemia decreases left ventricular systolic free wall strains. The myocardial adaptation does not change ventricular responses to acutely increased afterload.  相似文献   

8.
胎儿超声心动图评价胎儿心动过速的诊断及治疗干预   总被引:5,自引:0,他引:5  
目的应用胎儿超声心动图诊断胎儿快速心律失常并对宫内干预治疗室上性心动过速(SVT)进行跟踪评价。 方法对已检出的1910例心律失常胎儿中的125例快速心律失常者,分为窦性心动过速、SVT、SVT合并心力衰竭(心衰)3组,对后两组胎儿进行宫内地高辛转律治疗。 结果胎儿心动过速125例(心率≥180O次/min),其中SVT29例(含房颤、房扑7例);余为窦性心动过速96例。SVT组中合并复杂先天性心脏病者7例,胎儿水肿7例。合并先心病均于检查后中止妊娠,其余22例行常压氧治疗或经胎盘给药,首选药物为地高辛。新生儿随访期最长16个月,头颅CT、超声心动图等各项生理指标均正常。 结论胎儿超声心动图是目前唯一可迅速检出胎儿心律失常并明确性质的诊断手段,且重复性好。地高辛经胎盘给药治疗可有效转律并同时控制胎儿心衰减轻水肿且无致畸作用。  相似文献   

9.
二维超声"三切面"法筛查胎儿先天性心脏畸形   总被引:2,自引:2,他引:0  
目的 探讨应用二维超声"三切面"法筛查胎儿先天性心脏畸形的可行性及局限性. 方法 以四腔心、左心室、右心室流出道为筛查切面,筛查胎儿先天性心脏畸形.疑有异常者送上级医院行系统超声心动图检查,并追踪随访,与引产后尸检或出生后超声心动图对照. 结果 本法筛查获得较清晰的胎儿心脏二维结构图像.12 046例受检胎儿中,正确诊断胎儿心脏异常19例,误诊1例,漏诊2例,产前诊断符合率86.36%. 结论 应用二维超声采用四腔心加左右心室流出道切面法检查可清楚直观地观察胎儿心脏解剖结构,方法 简便可靠.  相似文献   

10.
目的评估3D/4D时间-空间相关成像(STIC)是否能比常规二维胎儿超声心动图提供更多胎儿心脏的切面及信息。方法采用3D/4DSTIC超声系统对26例孕龄16~41周的正常胎儿进行心脏和胸部的自动扫查,获得容积数据后进行脱机分析,主要对胎儿心脏的解剖结构进行多平面的观察和三维重建,重点观察胎儿心脏的流出道等结构。结果26例胎儿皆成功获得满意二维和三维四腔心切面的图像。通过STIC技术获得的容积数据显示了一系列相互垂直的三维平面图像(即A平面、B平面、C平面),对其中的每一幅图像都可通过旋转、平移进行控制、分析。切割或三维重建图像可获得比常规二维胎儿超声心动图检查更多的切面及信息。结论3D/4DSTIC技术比常规二维胎儿超声心动图检查能更快地提供更多的观察心脏解剖结构的切面和信息。  相似文献   

11.
OBJECTIVES: Tissue Doppler echocardiography (TDE) has been developed in adult cardiology, but only recently has it been applied to fetal heart studies. We implemented TDE on a high-resolution ultrasound system used for prenatal scanning by changing the Doppler settings, but without specific TDE equipment, to study cardiac tissue motion of normal fetuses in the second and third trimesters. METHODS: Using color Doppler settings optimized for low velocity motion assessment, detection rates of cardiac structures were measured in 47 fetuses. With pulsed Doppler, axial diastolic and systolic cardiac wall velocities were recorded in another 30 fetuses. RESULTS: In all fetuses TDE could detect cardiac wall motion. The right ventricular wall and the level of the atrioventricular valves were most easily seen. Axial contraction velocities of the fetal heart increased with gestational age. CONCLUSIONS: TDE can be used to study normal fetal cardiac function throughout gestation. A regular ultrasound system without additional hardware or software is suitable for screening studies using TDE.  相似文献   

12.
The aim of this study was to evaluate the use of 4-D echocardiography with inversion mode and spatiotemporal image correlation (IM-STIC) in the detection of normal and abnormal fetal hearts. We retrospectively studied 112 normal fetuses and 16 fetuses with a confirmed diagnosis of congenital heart disease. Two volumes were acquired from each of the fetuses using transverse and sagittal sweeps. Volumes were reconstructed with IM-STIC. In normal fetuses, IM-STIC facilitated visualization of the interior structures of the fetal heart and great vessels. The visualization rates of intended planes obtained from IM-STIC 4D data ranged from 55% to 100%. In 16 fetuses with congenital heart disease, IM-STIC was able to display the cardiac malformations using digital casting. Some of the malformations were suspected during pre-natal 2-D echocardiography, and their pre-natal IM-STIC diagnoses were confirmed by post-natal echocardiography, surgery and/or autopsy. Hence, 4-D IM-STIC allows better visualization of complex congenital heart disease and should be considered a very useful addition to 2-D echocardiography.  相似文献   

13.
目的应用二维应变成像测量妊娠糖尿病胎儿心室的二维应变,从而评估妊娠糖尿病胎儿心室的局部收缩功能。方法42例妊娠糖尿病胎儿为糖尿病组,60例正常胎儿为对照组,超声心动图测量其室壁厚度、左右心室射血分数,二维应变成像测量左右心室二维应变。结果与对照组比较,糖尿病组胎儿右心室射血分数、室间隔厚度及右心室游离壁厚度增加,左心室侧壁心尖段、右心室游离壁中间段、心尖段及室间隔心尖段收缩期二维应变减低,差异均有统计学意义(P〈0.05)。结论二维应变可以敏感地反映胎儿心室局部收缩功能,可用于妊娠糖尿病胎儿心功能的评估。  相似文献   

14.
目的探讨实时三维超声心动图(Live-3DE)在胎儿心血管超声成像中的应用的可行性。方法对21例孕龄17~36周的正常胎儿进行Live-3DE研究,观察胎儿多个常规检查切面及形态结构的相互关系,由2名胎儿超声心动图经验丰富的医师独立对胎儿解剖结构及关系能否显示进行评估,并对两者评估结果的一致性进行Kappa检验。结果19例胎儿取得清晰直观的四腔心观,五腔心观及左室流出道切面。7例取得肺动脉一动脉导管切面,5例取得三血管切面,3例取得主动脉弓切面。1例左心室强回声结构胎儿,RT-3DE清晰显示位于左室腱索乳头肌水平强回声结构的立体观。2名观察者之间的一致性在观察胎儿四腔心观,五腔心观,三血管切面,室间隔,卵圆窝,二尖瓣,三尖瓣等结构,以及二尖瓣与三尖瓣的关系,降主动脉与左房关系时为良好至优秀(K值为0.63~1.00),在观察左室流出道及右室内调节束时为中等(K值分别为0.48和0.42)。结论初步应用显示Live-3DE能够用于正常胎儿心血管结构及相关关系的立体三维显示,其在胎儿复杂先天性心血管畸形显示中的应用价值有待进一步深入研究。  相似文献   

15.
多普勒超声对正常胎儿心脏机械性PR间期的临床研究   总被引:2,自引:1,他引:1  
目的探讨多普勒超声对正常胎儿心脏机械性运动PR间期的检测方法。方法将受检胎儿300例分为早、中、晚孕3组,在标准胎儿左心室流人道及流出道切面上,运用彩色多普勒引导脉冲多普勒取样容积记录左心室流人道及流出道血流频谱,测量从舒张期二尖瓣A峰起始至收缩期主动脉射血起始的心房剑心窀的传导时间(PR问期),并同时测量收缩期主动脉射血起始至二尖瓣A峰开始的时间(VA间期)。结果胎儿孕周、心率、PR间期、VA间期的数值均呈正态分布,300例胎儿的平均孕周为(21.33±9.55)周,平均心率(152.34±10.83)次/min,平均PR间期(105.63±13.35)ms,平均VA间期(283.294±23.57)ms。不同孕期组间的孕周、胎儿心率、PR间期、VA间期的差异均有统计学意义(P=0.000),经SNK—q检验显示不同孕期组间两两差异均有统计学意义(P〈0.01)。结论应用多普勒超卢测量PR间期和VA间期方法简便,图像清晰且重复性好,该方法可对胎儿I度房室传导阻滞捉供诊断信息,并可对胎儿房室传导阻滞的防治和预后提供依据。  相似文献   

16.
目的评价胎儿心脏超声智能导航技术(5D Heart)在胎儿超声心动图五个快速筛查切面诊断要素中的应用价值。 方法选取2016年10月至12月在浙江大学医学院附属邵逸夫医院超声科接受胎儿超声心动图检查的中晚孕期单胎胎儿220例,使用容积探头对220例中晚孕期单胎胎儿采集以四腔心切面为初始切面的三维容积数据共384个,采用5D Heart后处理成像,获取5个快速筛查切面,对5个切面21个要素化内容进行评分,采用χ2检验比较5D Heart与传统技术在5个诊断切面的要素显示是否存在差异,采用Pearson相关分析对5D Heart技术与传统二维超声心动图在正常胎心及异常胎心组中要素显示率作相关性分析。应用秩和检验分别对同一观察者不同时间评分结果,2个经验相对不足的医师评分结果及其分别与经验丰富的医师的评分结果进行比较。 结果220例胎儿共获取384个容积数据,其中200例胎儿的317个心脏容积数据能够用于分析,获取成功率为82.6%。5D Heart技术与传统技术在胎儿心动图快速筛查5个切面要素的显示量,差异无统计学意义(χ2=5.17,P=0.27);正常胎心组与异常胎心组比较,切面要素显示率分别为89.6%、85.2%(r=0.94,P=0.02)。同一观察者不同时间评分结果比较、两个经验相对不足的医师比较以及分别与经验丰富的医师比较,评分结果差异无统计学意义(均P>0.05)。 结论胎儿心脏超声智能导航技术在获取胎儿快速筛查切面及显示胎儿超声心动图要素化诊断信息方面具有较高的可靠性及重复性,减少操作者技术经验的依赖性,在CHD胎儿图像规范化采集与分析、科研教学、远程会诊及基层医院筛查中具有重要的应用前景。  相似文献   

17.
目的探讨本中心32例胎儿孤立完全性肺静脉异位连接(TAPVC)产前超声的主要特征。方法选择我院经产前超声心动图检出孤立TAPVC病例32例,经出生后检查或尸检证实诊断,回顾性分析超声检查的图像和结果。结果本研究胎儿共诊断TAPVC 75例,孤立TAPVC 35例。单发病例诊断时孕周为22~38周,平均(27.5±4.5)周,年龄为21~38岁,平均(28.0±4.0)岁,其中引产23例,12例出生。出生后证实诊断的9例,假阳性3例。出生的9例TAPVC病例8例在新生儿期手术治疗,平均手术年龄8.6d,平均随访40.6个月(18~75个月)。引产病例由尸检证实诊断。总结可作为超声诊断特征的直接征象和间接征象:包括肺静脉共同腔、肺静脉回流完整途径(是否存在梗阻)、右心优势、左房后壁-降主动脉的距离、引流入血管(腔静脉和冠状窦)扩张等。结论胎儿孤立TAPVC产前超声具有特征性表现。产前系统检查可对TAPVC的分型及梗阻做出准确的判断,为孕妇制定最佳的生产计划和手术方案。  相似文献   

18.
The purpose of this study was to evaluate the feasibility of three-dimensional freehand echocardiographic assessment of ventricular volumetry in healthy fetuses and in fetuses with congenital heart disease. The study was approved by the hospital institutional review board. After echocardiographic examination by conventional ultrasonographic equipment interfaced with a magnetic tracking system, three-dimensional cardiac data were collected prospectively in 57 fetuses. Ventricular volumes were determined from three-dimensional data sets, and 22 fetuses with congenital heart disease were compared with 29 healthy fetuses. A multiple regression analysis of covariance was performed to assess between-group differences. Gated three-dimensional volume data sets enabled assessment of ventricular volumes in 51 of the 57 fetuses. Both fetuses with and without congenital heart disease had exponential increases in cardiac volumes during gestation. In fetuses with congenital heart disease and a marked inequality of ventricular size but no heart failure, the combined end-diastolic and stroke volumes of both ventricles were found to be significantly reduced compared with controls with no disease and fetuses with other types of congenital heart disease. Three-dimensional imaging can provide estimates of ventricular volume changes in fetal hearts with abnormal ventricular morphology that cannot easily be performed by two-dimensional echocardiography, and it may provide insight into evolving congenital heart disease.  相似文献   

19.
目的应用胎儿超声心动图定量分析卵圆孔瓣运动规律以及卵圆孔瓣宫内早闭的血流动力学特点。 方法选取2019年11月至2020年6月在北京百子湾和美妇儿医院进行产前检查,胎儿及母体均未发现异常的孕妇102 例为正常组,依据孕龄将正常组分为3组:组A孕28+0~32+6周36例,组B孕33+0~36+6周32例,组C孕37+0~40+6周34例。另选取超声心动图诊断为胎儿宫内卵圆孔瓣早闭且右心增大的孕妇14例为异常组。应用M型超声心动图检测胎儿卵圆孔瓣运动曲线,测量收缩期(S峰)和舒张期(D峰)运动峰值,S峰持续时间(ST),1个心动周期持续时间(T),S峰下降斜率,计算ST/T;应用多普勒超声测量肺动脉瓣、主动脉瓣、动脉导管血流速度,静脉导管阻力指数,脐静脉(腹段)血流速度,跨卵圆孔和下腔静脉入右心房血流速度;应用二维超声测量胎儿卵圆孔径,右心房与左心房横径比值(RA/LA)、右心室与左心室横径比值(RV/LV)。比较并分析各组之间以上参数的差异。 结果正常组胎儿卵圆孔瓣M型超声心动图特点为卵圆孔瓣运动曲线形成的S峰和D峰皆为向左心房单向运动,S峰最大运动峰值大于D峰。正常胎儿S峰最大运动峰值5~7 mm,平均(6.00±0.96)mm。M型超声心动图测量卵圆孔瓣运动曲线S峰运动最大峰值,卵圆孔瓣早闭组与正常组C比较差异有统计学意义[(3.72±0.54)cm vs (6.17±0.94)cm,P<0.001],ST/T卵圆孔瓣早闭组较正常组C减小,差异有统计学意义(0.52±0.86 vs 0.59±0.05,P<0.001)。卵圆孔瓣早闭组胎儿右心扩大,与正常组C比较,RA/LA增大,2组间差异有统计学意义(1.83±0.21 vs 1.19±0.19,P<0.001)。正常胎儿跨卵圆孔血流速度低于下腔静脉入口血流速度[(40.9±8.9)cm/s vs(52.5±11.5)cm/s,P<0.05],卵圆孔瓣早闭组跨卵圆孔血流速度高于下腔静脉入口血流速度[(47.9±10.6)cm/s vs(43.1±7.4)cm/s,P<0.05]。脐静脉血流速度正常组C高于卵圆孔瓣早闭组,差异有统计学意义[(24.4±4.47)cm/s vs(20.3±5.00)cm/s, P<0.05]。 结论M型超声心动图显示正常胎儿卵圆孔瓣运动曲线有其自身规律和特点,卵圆孔瓣宫内早闭胎儿卵圆孔瓣开放运动减低。应用M型超声心动图对卵圆孔瓣运动及血流动力学特点进行定量分析研究,有助于准确诊断卵圆孔瓣宫内闭合。  相似文献   

20.
胎儿实时三维(四维)超声心动图的初步临床应用   总被引:2,自引:2,他引:0  
目的 以胎儿四腔心容积为基础,通过后处理,与二维超声比较,探讨胎儿四维超声心动图在显示正常胎儿心脏和先天性心脏畸形胎儿中的临床应用。方法 对108例孕妇行胎儿心脏四维超声检查,其中84例心脏正常、24例先天心脏畸形。显示胎儿四腔心切面后启动四维容积扫查获得心脏灰阶容积和彩色多普勒血流容积,将图像储存后进行后处理。获取容积与后处理由同一医师完成。利用上述容积显示如下结构:四腔心(4C)、左心室流出道(LVOT)、右心室流出道(RVOT)、三血管气管(3VT)、二尖瓣(MV)、三尖瓣(TV)、主动脉(AO)、肺动脉(MPA)、主动脉弓(ARCH)、动脉导管(DA)。比较正常胎儿孕周≥28周和<28周胎儿在不同四腔心初始位置下对同一结构显示率的差异。所有四维超声心动图的诊断结果与二维超声比较,其中11例先天心脏畸形经产后解剖或生后超声心动图证实。结果 108例胎儿均获得心脏四维容积数据(100%)。每个对象扫查时间(7.53±2.37)min,5 s/容积。四腔心与房室瓣显示率100%。除主动脉弓外,心脏正常胎儿孕周≥28周对上述心脏结构的显示率高于<28周胎儿(P<0.05);除三血管气管切面外,心脏初始位置为心尖四腔心时对上述切面的显示率高于横位四腔心和心底四腔心(P<0.05)。孕周与胎心初始位置对显示率有显著影响,孕周大、初始位置为心尖四腔心切面获取成功率较高。先天性心脏畸形胎儿24例,四维超声心动图在显示瓣膜、瓣环及心脏间隔上显示出优势。结论 以四腔心为基础切面能够快速获取胎儿心脏容积,并能较为完整地评价胎儿心脏结构。胎儿四维超声心动图在显示复杂胎儿心脏异常中起到一定的作用。  相似文献   

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