产前超声检查对胎儿先天性心脏病诊断的临床价值

目的:探讨产前超声检查对胎儿先天性心脏病诊断的临床价值。材料与方法:选取201 1年1月至2014年1月于我院产科分娩待产产妇865例产妇作为研究对象,在孕期对所有产妇进行超声检查,采用五组基本切面扫查法确诊17例先天心脏病胎儿,之后对所有孕妇和新生儿跟踪调查。结果:确诊的17例先天心脏病胎儿,经引产后尸检及产后新生儿超声心动图检查证实,完全性心内膜塾缺损2例,左心发育不良综合征1例,法洛四联症2例,大血管转位1例,室间隔缺损8例,卵圆孔直径增大3例,但漏诊先天心脏病患儿5例,其中房间隔缺损1例,室间隔缺损4例,心脏五组基本切面对胎儿先天性心脏病筛查各切面显示率不同,四腔心切面明显高于其他方式(P<0.05)。结论:产前超声对胎儿心脏进行初步筛查能检查出先天性心脏病准确性较高,诊断价值较优,可适当的临床推广。     

心脏超声在胎儿先天性心脏病筛查中应用分析

目的:探讨心脏超声在胎儿先天性心脏筛查中的应用价值。方法:选取2016年3月至2018年2月期间于本院接受产前检查的孕妇952例作为研究对象,所有孕妇分别接受常规超声及心脏超声检查。记录胎儿先天性心脏病的筛查结果与诊断结果,并将该结果与新生儿超声检查结果/尸检结果进行对比;记录胎儿心脏超声检查诊断先天性心脏病的准确度、灵敏度及特异度;明确心脏超声不同切面的检查结果。结果:952名胎儿中,患有先天性心脏病的患儿有12例,其中11例经产前心脏超声检查出,准确率为91.67%(11/12),其中室间隔缺损2例,房间隔缺损1例,心内膜垫缺损2例,右心室发育不良1例,单心腔1例,三房心1例,三尖瓣下移1例,法洛四联症2例,新生儿筛查发现漏诊1例为室间隔缺损,漏诊率为8.33%;产前心脏超声检查与新生儿超声检查结果/尸检结果对比,差异无统计学意义(P0.05);胎儿心脏超声诊断准确度、灵敏度及特异度分别为99.68%、91.67%、99.79%;952名胎儿经产前心脏超声检查,有11例诊断为先天性心脏病,其中四腔心切面异常占36.36%,左心室/右心室流出道切面异常占18.18%,三血管/三血管气管切面异常的占45.45%。结论:心脏超声在胎儿先天性心脏筛查中具有较高的诊断准确度、灵敏度及特异度,且可通过不同的切面筛查降低误诊率及漏诊率,值得临床推广。     

超声系统诊断胎儿心脏病中应用心脏三节段诊断法的效果观察

目的:观察超声系统诊断胎儿心脏病中应用心脏三节段诊断法的效果。方法:随机选择本院自2016年1月至2017年3月检查的高危胎儿300例,300例高危胎儿均采用超声系统心脏三节段法进行诊断,诊断高危胎儿是否有心脏病,分析及评估其诊断准确率,并与胎儿产后超声心动图、引产后尸检结果进行对比。结果:经超声系统心脏三节段法诊断后发现,先天性心脏病胎儿有24例,检出率8%(24/300),24例胎儿中,有9例胎儿产后经超声心动图检查证实患有心脏病,15例胎儿经引产后尸检结果证实患有心脏病,此诊断方法与胎儿产后超声心动图、引产后尸检结果对比无差异,P0.05。结论:在胎儿心脏病诊断中,通过超声系统心脏三节段法进行诊断,可准确判断出胎儿是否出现先天性心脏病,可作为诊断胎儿先天性心脏病的常用方法,值得临床推广应用。     

超声心动图在胎儿先天性心脏病筛查中的应用价值

目的:探讨超声心动图在胎儿先天性心脏病(CHD)筛查中的应用价值。方法:对我院2015年2月~2017年8月临床就诊的624例孕妇进行胎儿超声心动图检查,通过胎儿四腔心切面、左右室流出道切面、三血管-气管平面、主动脉弓切面、动脉导管弓切面,重点观察胎儿心内结构及大血管连接情况,并与引产后尸体解剖及新生儿超声心动图筛查结果进行对比分析。结果:624例胎儿超声心动图,共发现胎儿心内结构异常15例,其中复杂性CHD 9例,单纯室间隔缺损3例,单纯房间隔缺损3例。漏诊2例,1例为肌部室间隔缺损,1例为部分型肺静脉异位引流。超声心动图对胎儿CHD诊断的准确率为88.2%(15/17)。结论:超声心动图是胎儿CHD安全可靠的影像学检查方法,根据心脏的各个切面和节段性分析法,可对本类疾病进行早期诊断。     

胎儿房室间隔缺损的产前超声诊断

房室间隔缺损电称房室管畸形，或心内膜垫缺损，是胎儿时期最为常见的先天性心脏病，如果包括房室间隔缺损的所有类型，约占胎儿先天性心脏病的17％～21％。与新生儿心脏超声检查比较，产前超声检出率较高，因为这种畸形在胎儿心脏四腔心切面容易识别，并常常伴随有心外畸形和较高的死亡率。本研究总结1990年～2003年我院产前超声检查诊断的26例胎儿房室间隔缺损的声像图特点和追踪结果，试图进一步探讨胎儿超声心动图产前诊断房室间隔缺损的临床价值。     

彩色多普勒超声对胎儿心脏病的诊断研究

目的 探讨彩色多普勒超声对胎儿心脏病的产前诊断价值。方法 随机对6000例孕妇进行胎儿超声心动图检查。结果 产前检出30例胎儿心脏病，16例经引产尸体解剖证实，产后彩超检查证实14例。声像图显示四腔心不对称者占30．0％（9／30），有室间隔缺损者占73．3％（22／30）。结论 常规胎儿心动图检查对产前检出胎儿心脏病具有重要的临床价值；四腔心不对称和室间隔缺损是胎儿心脏病最主要的声像图表现。     

超声心动图在诊断胎儿室间隔缺损中的应用

目的:探讨彩色多普勒超声心动图产前诊断室间隔缺损的临床价值。方法:在胎儿四腔心切面、五腔心切面和流出道长轴切面重点观察室间隔有无中断,应用彩色多普勒超声观察有无穿隔彩色血流和分流频谱,并多切面观察有无其他心内畸形。结果:筛查胎儿心脏5200例,共检出和诊断各种胎儿心脏结构异常120例,其中单纯VSD61例。38例产后超声心动图与产前超声诊断相符,2例缺损产前复查时宫内自然愈合,11例经手术证实,6例经引产后尸解证实,4例失访。结论:产前彩色多普勒超声心动图对诊断产前胎儿室间隔缺损具有重要的临床价值。     

胎儿复杂先天性心脏病超声诊断与病理解剖结果的对比研究

目的 探讨胎儿超声心动图诊断复杂先天性心脏病的临床价值.方法 对49例胎儿复杂性先天性心脏病超声诊断结果与引产后胎儿尸检心脏病理解剖结果进行对比分析.结果 产前超声诊断与病理解剖符合42例(85.71%),产前超声诊断与病例解剖结果不一致7例,其中3例产前诊断不符合,4例为不完全符合.24例合并心脏外其他畸形,9例染色体异常.结论 胎儿超声心动图诊断胎儿复杂先天性心脏病具有较高的准确性,但部分心脏畸形产前难以检出.     

胎儿复杂先天性心脏病超声诊断与病理解剖结果的对比研究

目的 探讨胎儿超声心动图诊断复杂先天性心脏病的临床价值.方法 对49例胎儿复杂性先天性心脏病超声诊断结果与引产后胎儿尸检心脏病理解剖结果进行对比分析.结果 产前超声诊断与病理解剖符合42例(85.71%),产前超声诊断与病例解剖结果不一致7例,其中3例产前诊断不符合,4例为不完全符合.24例合并心脏外其他畸形,9例染色体异常.结论 胎儿超声心动图诊断胎儿复杂先天性心脏病具有较高的准确性,但部分心脏畸形产前难以检出.     

胎儿复杂先天性心脏病超声诊断与病理解剖结果的对比研究

目的 探讨胎儿超声心动图诊断复杂先天性心脏病的临床价值.方法 对49例胎儿复杂性先天性心脏病超声诊断结果与引产后胎儿尸检心脏病理解剖结果进行对比分析.结果 产前超声诊断与病理解剖符合42例(85.71%),产前超声诊断与病例解剖结果不一致7例,其中3例产前诊断不符合,4例为不完全符合.24例合并心脏外其他畸形,9例染色体异常.结论 胎儿超声心动图诊断胎儿复杂先天性心脏病具有较高的准确性,但部分心脏畸形产前难以检出.     

Indications for fetal echocardiography from a tertiary-care obstetric sonography practice

PURPOSE: The present study was conducted to evaluate the indications for fetal echocardiography in a tertiary-care obstetric sonography practice and to determine the incidences of confirmed congenital heart disease for each primary indication. METHODS: A retrospective analysis of all pregnant women referred to a pediatric cardiology unit for fetal echocardiography by the tertiary-care sonography unit over a 2-year period was performed. The primary indications for referral for fetal echocardiography were obtained from the sonographers' reports. Outcome data were extracted from the fetal echocardiograms, postnatal echocardiograms or pathology and autopsy reports, and patient medical records. RESULTS: Of 6,002 pregnant women who had undergone prenatal sonographic examination during the study period, 275 (4.6%) had been subsequently referred for fetal echocardiography. The most common primary indication for referral had been abnormal cardiac findings on the prenatal sonographic examination, which had been present in 64 (23.3%) of the 275 cases. In 44 (69%) of those 64 cases, congenital heart disease had been confirmed. Among the 211 patients who had had normal cardiac findings on prenatal sonography but had been referred for fetal echocardiography owing to other primary indications, congenital heart disease had been confirmed in only 7 cases (3.3%). CONCLUSIONS: An abnormal cardiac finding during prenatal sonographic examination is a common primary indication for fetal echocardiography and is more useful for identifying congenital heart disease than are other risk factors. Careful routine cardiac screening during routine prenatal sonographic examination may facilitate further investigation and treatment.     

先天性心脏病胎儿胎盘病理特征分析

目的探讨先天性心脏病胎儿胎盘病变的病理特征。 方法选取2010年8月至2014年4月首都医科大学附属北京安贞医院超声心动图二部胎儿心脏病母胎医学会诊中心胎儿心脏病母胎医学数据库样本库中先天性心脏病胎儿20例（心脏病组,均为心脏畸形引产胎儿）,另选取产前超声及产后检查均正常,但因胎膜早破、羊水过少、妊娠期糖尿病、子痫前期、胎儿窘迫、先兆临产、孕妇心律失常引产的胎儿34例（对照组）,对两组胎儿产前超声及产后胎盘病理检查结果进行分析。 结果先天性心脏病组胎儿中17例为妊娠中期胎盘,3例为妊娠晚期胎盘;对照组34例均为妊娠晚期胎盘。产后胎盘病理检查显示：（1）心脏病组20例胎儿胎盘病变18例（18/20）,以重度绒毛膜炎（77.8%,14/18）、灶状钙化（44.4%,8/18）和血栓形成（16.7%,3/18）为主,1例胎盘梗死,2例胎盘脐带未见显著变化。（2）心脏病组10例致死性先天性心脏病胎儿的胎盘病变重于10例非致死性心脏畸形胎儿。（3）对照组34例（34/34）胎儿均显示胎盘病变,以轻度绒毛膜炎（61.8%,21/34）、灶状钙化（79.4%,27/34）、纤维素样物沉着为主（97.1%,33/34）,部分为重度绒毛膜炎（26.5%,9/34）。（4）心脏病组与对照组胎儿胎盘病理检查结果对照显示,心脏病组胎儿的胎盘病变程度重于对照组胎儿;两组胎儿胎盘病变的病理特征不同,超声表现亦不同。 结论先天性心脏病组胎儿胎盘重度绒毛膜炎、灶状钙化和血栓形成影响母胎血液循环及营养物质交换,可能与先天性心脏病的发生有相关性。     

胎儿四腔心筛查的价值分析

目的：探讨将胎儿四腔心作为先天性心脏病筛查方法的优缺点,探讨提高胎儿先心病早期诊断的最佳方法。方法：970例中孕以后例行超声检查的孕妇（其中310例高危孕妇）,进行胎儿四腔心切面的筛选性检查,发现可疑异常后加做全套胎儿超声心动图,将结果与胎儿尸检查或产后超声心动图相对照。结果：胎儿四腔心的显示率为100％,胎心照射时间＜5min,共检出胎儿心脏异常9例（0．93％）,其中尸检证实5例,漏诊大动脉畸形2例（0．2％）。结论：胎儿四腔心作为先心病的初筛手段简便易行,可发现大多数先心病,但会漏诊大动脉畸形,故最佳的筛查组合应为四腔心＋两心室流出道切面。     

染色体22q11.2微缺失检测在先心病产前诊断中的应用

目的研究先心病胎儿中染色体22q11.2微缺失综合征的发生率,探讨在先心病胎儿中进行22q11.2微缺失产前诊断的必要性及可行性。方法选择2014年1月到2019年12月在本院妇产科经胎儿超声检查诊断为先天性心脏畸形的228例胎儿,行绒毛取样、羊膜腔穿刺或脐血穿刺获取胎儿细胞。综合应用染色体核型分析、多重连接依赖探针扩增、荧光原位杂交及单核苷酸多态性微阵列芯片等多种检测技术,对胎儿进行细胞遗传学水平的检测。结果 228例样本中发现染色体非整倍体64例,其中21三体25例、18三体30例、13三体4例、45,X 2例、48,XXY,+18 1例、染色体三倍体2例。对164例染色体核型未见异常者,行全基因组SNP微阵列芯片分析发现9例22q11.2微缺失,22q11.2微缺失在先心病胎儿中的发生率为5.49%。结论胎儿先天性心脏缺陷与染色体22q11.2微缺失有关。在先心病胎儿中行22q11.2微缺失产前诊断是必要可行的,对于优生优育、明确胎儿预后及再发生育风险评估有重要意义。     

胎儿超声心动图在胎儿先天性心脏病产前诊断中的临床价值

目的 探讨胎儿超声心动图在产前诊断胎儿先天性心脏病的临床意义。方法 选择妊娠＞16周,分娩前有高危倾向的孕妇310例行胎儿超声心动图检查。检查中着重观察胎儿腹部切面、胎儿四腔心切面、胎儿左右室流出道长轴或大动脉短轴切面、胎儿主动脉弓长轴切面。结果 共发现9例先天性心脏病胎儿,其中复杂先天性心脏病7例、单纯室间隔缺损1例、1例出生前未确诊,出生后诊断为法洛四联症。敏感性82％,特异性100％。结论 胎儿超声心动图早期诊断胎儿畸形,评价胎儿心功能的有用工具。其诊断的准确性受孕妇体形、胎儿体位以及检查者的经验积累等多方面因素的影响。     

Prenatal detection of congenital heart disease in southern Nevada: the need for universal fetal cardiac evaluation.

OBJECTIVE: Congenital cardiac malformations are common developmental anomalies. In the United States, congenital heart disease is the number one cause of infant mortality from congenital malformations. Prenatal diagnosis of congenital heart defects aids treatment coordination. Our aim was to evaluate prenatal detection of serious congenital heart malformations in Clark County, Nevada. METHODS: We electronically searched our research department-maintained computer database for patients with serious congenital heart disease born in Clark County between May 2003 and April 2006. We excluded patients that did not have at least 1 local prenatal ultrasound examination. All pre-natal ultrasound studies were performed in obstetric offices, radiology imaging centers, or maternal-fetal medicine specialty practices. Fetal echocardiography was performed in maternal-fetal medicine specialists' offices under the supervision of a fetal cardiologist. Pediatric cardiologists performed all postnatal echocardiographic examinations. RESULTS: During the study period, we diagnosed serious congenital heart malformations in 161 patients among a total estimated 77,000 births (2/1000). Of the 161 patients, 58 (36%) had a prenatal diagnosis, and 103 (64%) had an exclusively postnatal diagnosis. CONCLUSIONS: Standard prenatal ultrasound fails to show congenital heart disease in most fetuses.     

超声监测筛查胎儿先天性心脏畸形

目的 探讨超声监测筛查胎儿先天性心脏畸形的可行性及临床应用价值。方法 对常规产前超声检查在胎心四腔观中疑有异常，临床发现胎儿心律不齐，以及母体有高危因素共20例行超声心动图检查。以观察胎儿四腔观为基础，酌情增加长轴、短轴、主动脉弓等切面观，并适当配合彩色多普勒及脉冲多普勒超声检查。结果 超声检查发现的20例先天性心脏异常中，17例先天性心脏病，其中1例右位心并完全性内脏转位，1例为单纯性室内隔缺损（生后证实其染色体为21三体），15例复杂性先天性心脏病；3例心脏肿瘤，其中2例为室间隔横纹肌瘤，1例为心室壁横纹肌瘤。20例心脏异常病例中4例同时合并其他器官结构异常，7例右位心及不同程度内脏转位，8例脐动脉A/B值异常，4例心律紊乱。结论 产前超声筛查胎儿先天性心脏畸形切实可行。对有高危因素、胎儿心律失常及其他内脏畸形者，应重点行超声心动图检查。     

Comparison of prenatal ultrasound and postmortem findings in fetuses and infants with congenital heart defects.

OBJECTIVE: Detection of congenital heart defects by prenatal ultrasound examination has been one of the great challenges since the investigation for fetal anomalies became part of the routine fetal examination. This prospective study was designed to evaluate the concordance of prenatal ultrasound findings with autopsy examination in a population consisting of both referred women and non-selected pregnant women. DESIGN: Criteria for inclusion were an ultrasound examination at the National Center for Fetal Medicine and an autopsy performed during the years 1985-94. Results from the ultrasound and autopsy examinations were systematized into categories depending on the degree of concordance. RESULTS: Of 408 infants and fetuses with developmental anomalies, 106 (26%) had congenital heart defects. In 63 (59%) of these 106 cases, the heart defect was the principal reason for the termination of pregnancy or the cause of death. Excluding five cases with a secundum atrial septal defect, there was complete agreement between the ultrasound examination and the autopsy findings in 74 (73%) of 101 cases. In 18 cases, there were minor discrepancies between ultrasound and autopsy findings. The main diagnosis was thus correct in 92 cases (91%). From the first time period (1985-89) to the second (1990-94), the detection rate of all heart defects increased from 48% to 82%. CONCLUSION: This study confirms a good correlation between ultrasound and autopsy diagnoses in fetuses and infants with congenital heart defects. A significant improvement in the detection of heart defects occurred from the first time period to the second and was probably due to increased experience and technical advances.     

超声心动图不同切面筛查胎儿先天性心脏病的敏感性研究

目的探讨超声心动图各常用切面观在筛查胎儿先天性心脏病中的敏感性,寻找一种操作更简便,诊断准确性更高的最佳切面。方法应用四腔心切面观（4cv）、四腔心切面加主动脉根部短轴切面观（4CV＋AR～SAV）、四腔心切面加左右室流出道切面观（4CV＋VOTV）、四腔心切面加三血管平面观（4CV＋3VV）、四腔心切面加三血管-气管平面观（4CV＋3VVT）筛查2600例孕22～38周的胎儿,比较各切面诊断先天性心脏病的敏感性。结果超声检查胎儿先天性心脏病40例,经引产和产后证实39例。4CV、4CV＋（AR—SAV）、4CV＋VOTV、4CV＋3VV和4CV＋3VVT筛查胎儿先天性心脏病的敏感性分别为49％、62％、75％、90％和90％。结论4CV＋VOTV、4CV＋3VVT筛查胎儿先天性心脏疾病的敏感性高,4CV＋VOTV＋3VVT可作为产前筛查胎儿先天性心脏病的常规检查切面。     

二维超声在胎儿先心病筛查中的应用

目的 探讨二维超声在胎儿先天性心脏病筛查中的应用,提高胎儿先天性心脏病的检出率。方法 以四腔心,左室长轴及心底短轴为主要切面,对3825例孕18周以上胎儿心脏进行初步筛查,并随访在本院分娩的新生儿,证实有先天性心脏病者,追踪其母孕期超声检查结果,对比先天性心脏病类型。结果 共检出心脏畸形8例,检出率0．21％。其中心内膜垫缺损2例,右室双出口1例,功能单心室1例,左室发育不良2例,室间隔缺损2例。其中6例为复杂重症先心病,占75％。2例室间隔缺损均大于6mm,并伴有心外畸形。结论 二维超声对胎儿心脏进行常规初步筛查,能够发现大多数胎儿心脏畸形,可作为初步筛查复杂先心病的方法。