单心动周期实时三维超声心动图在胎儿房室间隔缺损诊断中的应用

目的:探讨单心动周期实时三维超声心动图(s RT-3DE)在胎儿房间隔缺损(ASD)及室间隔缺损(VSD)诊断中的临床应用价值。方法:将满足纳入条件的320例孕妇,分别进行胎儿心脏二维超声心动图(2DE)及s RT-3DE检查,对两种检查方法的胎儿图像进行采集、结果记录以及数据进行分析比较,并对产前诊断为ASD及VSD的41例孕妇产后进行追踪随访,对婴幼儿行2DE检查。结果:320例孕妇中,对单纯性ASD或有ASD的胎儿,s RT-3DE产前诊断16例(5.00%),高于2DE产前提示诊断6例(1.88%),差异有统计学意义(P0.05);对单纯性VSD或有VSD的胎儿,s RT-3DE产前诊断25例(7.81%),高于2DE产前诊断12例(3.75%),差异有统计学意义(P0.05)。随访到28例患儿,1例为假阳性,生后检查未见室间隔连续性中断。结论:s RT-3DE可较直观显示胎儿室间隔、房间隔及卵圆窝的成像,在产前诊断胎儿房室间隔缺损中具有一定优势。     

胎儿心脏锥干畸形产前诊断评价

目的评价胎儿心脏锥干畸形产前超声心动图诊断准确性。方法运用胎儿超声心动图进行先天性心脏病产前诊断，并与心脏病理诊断或新生儿心脏超声诊断进行比较分析。结果2063例胎儿进行心脏超声检查，产前发现胎儿心脏锥干畸形28例，诊断时平均孕周26．6周（16～40周），产前诊断包括大血管转位5例，法洛四联症5例，右室双出口6例，永存动脉干9例，室间隔缺损合并主动脉骑跨可能1例，2例检查发现大血管位置异常但胎儿超声心动图未予明确诊断。24例经胎儿心脏病理检查或新生儿心脏超声检查确诊，4例失访（包括1例TOF／TA？，2例“大血管发育异常”，1例TGA）。比较产前诊断与产后诊断，分析大血管位置关系诊断准确性为75．0％（18／24）。结论胎儿超声心动图可正确诊断胎儿心脏锥干畸形，需运用多种超声切面及彩色脉冲多普勒确定大血管位置关系。     

超声心动图的四腔心切面产前诊断胎儿先天性心脏病的价值

目的 探讨超声心动图的四腔心切面（四腔心切面）产前诊断胎儿先天性心脏病（先心病）的价值。方法 回顾性分析780例妊娠16-36周通过四腔心切面进行产前诊断是的孕妇及其新生儿的临床资料。结果 780例胎儿中,94.6%,(738/780)的胎儿可以获取满意的四腔心切面,其中3例胎儿异常,1例为三尖瓣下移畸形（Ebstein综合征）,1例为严重的室间隔缺损,1例为单心房单心室和主动脉狭窄,例1和例3分别于出生后行尸体解剖和新生儿超声心动图检查,均符合产前诊断,例2出生后超声心动图检查证实为单心房和单心室,其余777例新生儿中,出生后身体检查并追踪至产后6周,发现3例先心病,其中1例室间隔缺损,1例房间隔缺损,1例房间隔缺伴肺动脉狭窄,四腔心切面诊断胎儿先心病的敏感性为50%,特异性为100%。结论 四腔心切面可以显示胎儿心脏的大部分结构,探测成功率高,对先心病的宫内诊断有较高的敏感性和极高的特性,可将胎儿四腔心切面作为常规的产检查项目。     

产前超声诊断胎儿右室双出口20例

目的:探讨产前超声检查诊断胎儿右室双出口的临床价值.方法:对20例右室双出口胎儿超声心动图资料进行回顾性分析总结.结果:产前诊断胎儿右室双出口20例,11例引产后病理证实,l例产后病理证实为完全性大动脉转位,1例产后经超声心动图确诊,余7例失访.结论:胎儿右室双出口的声像图特征:主动脉、肺动脉根部平行排列且均发自右心室...     

超声监测胎盘血管瘤24例分析

目的：探讨联合应用多种超声检查方法产前监测胎盘血管瘤的方法和价值。方法：回顾性分析和总结24例胎盘血管瘤的声像图、病理及临床资料。结果：24例中有22例经产前超声诊断,超声检出率为92%。瘤体最大116 mm×106 mm×72 mm,最小30 mm×20 mm×20 mm。并发症包括羊水过多（4例）、胎儿畸形（4例）、早产（3例）、新生儿窒息（2例）和妊娠期高血压疾病（4例）等。应用胎儿超声心动图监测胎儿心功能7例,指导临床选择适当的治疗时机。声像图表现为实质型（20例）和混合型（2例）。结论：超声检查是产前监测胎盘血管瘤的首选方法和有利工具。二维超声可以发现胎盘血管瘤并监测肿瘤的生长速度,彩色多普勒超声可以观测肿物的血流状态,胎儿超声心动图检查技术（包括胎儿心输出量的计算）可以监测胎盘血管瘤对胎儿循环、心脏功能的影响,及时为临床医生提供诊断依据,选择治疗和处理的时机。     

产前超声诊断胎儿右房异构一例

本文报道产前超声诊断胎儿右房异构一例。孕妇孕24周产前超声检查发现胎儿左位心合并复杂心血管畸形(右心室双出口、房室间隔缺损、肺动脉发育不良、双侧上腔静脉、心下型完全型肺静脉异位引流)、胃泡位于腹腔右侧、中位肝、可疑无脾、腹主动脉与下腔静脉位于脊柱左侧、双侧支气管呈右侧支气管对称形态,综合考虑右房异构可能。引产后经尸体解剖证实脾脏发育不良、右房异构。右房异构常合并复杂心血管畸形,因此产前超声发现复杂心血管畸形时,应警惕右房异构的可能。右房异构病死率极高,产前诊断具有重要意义。     

超声诊断胎儿鼻泪管囊肿1例

目的：探查胎儿鼻泪管囊肿的产前三维超声声像图特征。方法：采用二维及三维超声对鼻泪管囊肿胎儿行超声检查,总结鼻泪管囊肿产前超声声像图特征。结果：胎儿鼻泪管囊肿主要声像图特征是内眦下方呈类圆形无回声区,内径8mm,边界清,壁较光滑,内透声好。结论：产前三维超声能较好显示胎儿鼻泪管囊肿,并能监测其发展与转归,是诊断该病首选方法。     

超声心动图诊断胎儿心律失常的声像表现

目的 :探讨超声心动图诊断胎儿心律失常的声像表现。方法 :应用彩色多普勒超声诊断仪对孕妇年龄 2 0～ 32岁、胎龄 17～ 4 0周、临床疑有胎儿心律失常或伴其他异常妊娠史的 32 5例胎儿进行超声心动图检查。通过分析超声心动图特征 ,明确房室激动顺序和时相关系 ,分类诊断胎儿心律失常。对出生后仍有心律失常的新生儿进行超声心动图与心电图同步检查验证。结果 :32 5例高危胎儿中产前超声心动图诊断胎儿心律失常 5 5例 ,其中房性早搏 2 9例 ,室性早搏 9例 ,心动过缓 7例 ,窦性心动过速 4例 ,室上性心动过速 2例 ,房室传导阻滞 2例 ,房性早搏合并窦性静止 2例。出生后仍有心律失常的 4例新生儿进行超声心动图与心电图同步检查证实结果一致。结论 :超声心动图能诊断多种类型的胎儿心律失常 ,具有重要的临床意义     

超声与磁共振成像诊断胎儿脊柱与脊髓发育异常的对照研究

目的 比较产前超声检查、磁共振成像(MRI)用于诊断胎儿脊柱与脊髓发育异常的临床价值.方法 选择产前超声检查显示胎儿脊柱与脊髓发育异常的30例孕妇(其中脊柱排列不规则19例、椎管局部增宽7例、脊柱曲度异常4例),年龄22～41岁,孕龄23～38周,在超声检查后72 h内行MRI检查.30例孕妇中选择引产者25例,选择继续妊娠者5例.经患者知情同意,对引产后患儿行尸体解剖(尸解,22例)或尸体影像学检查(3例);对选择继续妊娠者,新生儿出生后12个月内行MRI随访.结果 (1)诊断符合率:19例产前超声显示脊柱排列不规则的胎儿中,产前超声正确诊断8例,分别为3例脊膜膨出、1例隐形脊柱裂、1例脊髓脊膜膨出、3例半椎体,产前超声诊断正确率为42%(8/19);而MRI正确诊断17例,只有1例半椎体和1例蝴蝶椎未能明确诊断,MRI诊断符合率为89%(17/19).7例超声显示椎管局部增宽的胎儿中,产前超声正确诊断0例,符合率为0,MRI正确诊断7例,符合率为7/7.4例超声显示脊柱曲度异常的胎儿中,产前超声正确诊断2例,为尾退化综合征和颈椎过度反曲各1例,符合率为2/4,MRI正确诊断3例,只有1例背侧皮毛窦未能正确诊断,MRl诊断符合率为3/4.(2)MRI的优势:MRI与超声诊断一致9例、纠正超声诊断6例、确诊超声可疑的诊断1例、完善超声诊断11例,MRI和超声均漏诊半椎体、蝴蝶椎和背侧皮毛窦各1例.超声漏诊病例多为脊髓病变,且声像图表现无特异性.结论 MRI可直接显示脊髓及其病变,在评价胎儿脊柱与脊髓发育异常方面是对超声显像的补充,能显著提高诊断的准确性.     

彩色多普勒超声在非高危胎儿产前心脏筛查中的临床意义

目的：探讨彩色多普勒超声在非高危胎儿产前心脏筛查中的临床意义。方法：选用我院1125例产前孕检的孕妇，通过多普勒超声的多切面检查，获得较为清晰的二维和彩色多普勒声像图，检查心脏畸形。结果：检查出9例先天性心脏病患者，其中通过产前超声筛查出7例，漏诊2例（室间隔缺损、法洛四联症），经伦理委员会和家属的同意，对引产后患儿进行尸解证实主要原因是由于母体的羊水少、胎儿体位异常、母体腹壁厚。多普勒超声对非高危胎儿的检出率0．6％，对心脏畸形的检查率是78％，诊断准确率是100％。结论：多普勒超声对非高危胎儿进行产前心脏超声筛查，检查率比较高，能够及时发现心脏畸形和做出相应的干预处理。     

Prenatal diagnosis of an aorto-pulmonary window by fetal echocardiography

Congenital aorto-pulmonary window or congenital aorto-pulmonary septal defect is a rare fetal malformation usually diagnosed after birth by echocardiography and usually associated with other congenital cardiovascular abnormalities (interrupted aortic arch, ventricular septal defect, atrial septal defect, tetralogy of Fallot). The authors report the first case of prenatal diagnosis of an aorto-pulmonary window associated with a ventricular septal defect identified by fetal ultrasonography at 28 weeks of pregnancy. The diagnosis was based on the echocardiographic images of normal semilunar aortic and pulmonic valves with evidence of a septal defect between the ascending aorta and pulmonary artery. The purpose of this report is to demonstrate the feasibility of antenatal diagnosis of this fetal malformation and help professionals who would be faced with such an unexpected prenatal image.     

Ultrasonic evaluation of the fetal heart. A report of experience and anatomic correlation.

Identification of fetal intracardiac structures in utero is accomplished with B-scan, gray-scale ultrasonography. Sagittal and transverse ultrasonographs of the interventricular septum, aortic root, tricuspid, and mitral valves are presented. These structures are characterized with respect to their relations to each other, atrial and ventricular chambers, and acoustic appearances. Correlation of these cardiac structures is made with gross anatomic fetal specimens sectioned in longitudinal and transverse planes. Recognition of fetal intracardiac detail may be of aid in future noninvasive investigations of human fetal cardiovascular dynamics.     

Prenatal diagnosis of complete atrioventricular septal defect with truncus arteriosus

Truncus arteriosus (TA) is a rare cardiac anomaly constituting less than 1% of all congenital heart defects. Its association with complete atrioventricular septal defect (AVSD) is extremely unusual and only 12 cases diagnosed postnatally or postmortem have been reported so far. We describe the first case of truncus arteriosus with AVSD to be diagnosed prenatally by fetal echocardiography.     

Aortopulmonary window with atrial septal defect: prenatal diagnosis, management and outcome

A case of prenatally diagnosed aortopulmonary window is reported. The mother was referred for fetal echocardiography at 26 weeks' gestation because of suspected congenital heart disease. Prenatal echocardiography showed an aortopulmonary septum defect close to the pulmonary artery bifurcation and a left-to-right shunt flow in systole and early diastole detected by color flow Doppler. Postnatal echocardiography confirmed prenatal diagnosis, the aortopulmonary window was a 9-mm type III aortopulmonary window. An atrial septal defect with shunt flow left to right was also found. Surgical repair was performed 4 weeks after birth, the postsurgical period was uneventful and the newborn was discharged without complications 7 days after surgery.     

Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies

Objective: To detect the structural and functional changes of fetal hearts in diabetic pregnancies by using Doppler echocardiography. Methods: This prospective study included 119 pregnant women divided into three groups. Group 1 included 47 pregnant patients with pre-existing diabetes mellitus (DM), group 2 included 40 patients with gestational diabetes and group 3 included 32 non-diabetic pregnant women. M-mode echocardiography was used to measure the thickness of the fetal ventricular walls and interventricular septum. The mitral and tricuspid early (E) and late (A) diastolic velocities and the ventricular shortening fraction were measured. Results: HbA1c % was significantly lower in gestational diabetes group compared with the pre-existing diabetes group. The interventricular septum was significantly thicker in the pre-existing diabetes group compared with other groups. Tricuspid and mitral E/A ratios were significantly lower in the pre-existing diabetes group compared with gestational diabetes and control groups. Moreover, there were no significant differences in the tricuspid and mitral E/A ratios between gestational diabetes group and the control group. The right and left ventricular shortening fractions were similar in the three groups. Conclusion: Fetuses of women with well-controlled gestational diabetes lack the diastolic dysfunction that is present in fetuses of women with pre-existing diabetes     

彩色多普勒超声心动图检测胎儿先天性心脏病

目的　探讨彩色多普勒超声心动图检测胎儿先天性心脏病 (先心病 )的可行性。　方法　 2 96例胎儿分为两组 :14 2例有高危因素的胎儿 ,15 4例正常妊娠胎儿。应用多普勒测定胎儿心脏各切面 ,并在生后作超声心动随访。　结果　在 14 2例有高危因素的胎儿中 ,发现胎儿先心病 5例 ,其中右心发育不良综合征 1例、法洛四联症 2例、单纯性室间隔缺损 (室缺 ) 2例。漏诊 2例 ,为单纯性室缺1例及房间隔缺损 1例。 15 4例正常妊娠胎儿中未发现先心病。生后超声心动随访或引产尸检结果与产前诊断相符。　结论　彩色多普勒超声心动图在诊断胎儿先心病方面是比较准确和安全的 ,对高危孕妇需加强胎儿先心病的检测     

Four-dimensional ultrasonography of the fetal heart with spatiotemporal image correlation

OBJECTIVE: This study was undertaken to describe a new technique for the examination of the fetal heart using four-dimensional ultrasonography with spatiotemporal image correlation (STIC). STUDY DESIGN: Volume data sets of the fetal heart were acquired with a new cardiac gating technique (STIC), which uses automated transverse and longitudinal sweeps of the anterior chest wall. These volumes were obtained from 69 fetuses: 35 normal, 16 with congenital anomalies not affecting the cardiovascular system, and 18 with cardiac abnormalities. Dynamic multiplanar slicing and surface rendering of cardiac structures were performed. To illustrate the STIC technique, two representative volumes from a normal fetus were compared with volumes obtained from fetuses with the following congenital heart anomalies: atrioventricular septal defect, tricuspid stenosis, tricuspid atresia, and interrupted inferior vena cava with abnormal venous drainage. RESULTS: Volume datasets obtained with a transverse sweep were utilized to demonstrate the cardiac chambers, moderator band, interatrial and interventricular septae, atrioventricular valves, pulmonary veins, and outflow tracts. With the use of a reference dot to navigate the four-chamber view, intracardiac structures could be simultaneously studied in three orthogonal planes. The same volume dataset was used for surface rendering of the atrioventricular valves. The aortic and ductal arches were best visualized when the original plane of acquisition was sagittal. Volumes could be interactively manipulated to simultaneously visualize both outflow tracts, in addition to the aortic and ductal arches. Novel views of specific structures were generated. For example, the location and extent of a ventricular septal defect was imaged in a sagittal view of the interventricular septum. Furthermore, surface-rendered images of the atrioventricular valves were employed to distinguish between normal and pathologic conditions. Representative video clips were posted on the Journal's Web site to demonstrate the diagnostic capabilities of this new technique. CONCLUSION: Dynamic multiplanar slicing and surface rendering of the fetal heart are feasible with STIC technology. One good quality volume dataset, obtained from a transverse sweep, can be used to examine the four-chamber view and the outflow tracts. This novel method may assist in the evaluation of fetal cardiac anatomy.     

A case of single umbilical artery with various fetal anomalies: correlations between prenatal ultrasonographic diagnosis and autopsy

We report a case of a single umbilical artery with various fetal anomalies, and a comparative study between prenatal ultrasonographic diagnosis and autopsy was done. The prenatal ultrasonographic diagnosis included, atrial septal defect (ASD), ventricular septal defect (VSD), mitral atresia or stenosis and a single great vessel. At autopsy, ASD, VSD, mitral atresia, overriding aorta and pulmonary atresia were evident. In case of other anomalies, the findings in the prenatal diagnosis and at autopsy were encephalocele, adrenal hypoplasia and a single umbilical artery. The ultrasonic detection of these anomalies is discussed and the limitations of this diagnostic method are given attention.     

胎儿先天性心脏病和风疹病毒感染的关系

目的 探讨和分析孕妇风疹病毒感染与胎儿先天性心脏病(简称先心病)的关系,为提高先天性风疹综合征产前诊断率寻求方法.方法 对超声心动图诊断并要求引产的38例先心病胎儿行脐带穿刺,采用酶联免疫吸附试验测定脐血风疹病毒特异性抗体IgM. 结果 38例先心病胎儿中18例脐血风疹病毒IgM(+),占47.4%,其余20例IgM(-).18例风疹病毒IgM(+)胎儿按心脏异常结构出现频率排序:室间隔缺损10例、肺动脉发育异常9例、房室瓣异常6例、大动脉转位5例、主动脉骑跨4例.IgM(+)和IgM(-)组中属于圆锥动脉分隔异常或圆锥动脉干间隔旋转不足或方向相反的病例数分别为11例(61.1%)和5例(25.0%)(P<0.05). 结论 风疹病毒与胎儿先心病的发生有一定关联,可能影响胎儿心室分隔和圆锥动脉干发育.B超提示胎儿室间隔缺损、肺动脉发育异常、心肌瓣膜异常、大动脉转位时,应考虑到风疹病毒感染的可能.