正常胎儿彩色多普勒超声心动图分析

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。     

产前超声检测中孕期胎儿心脏发育

目的 建立21~25孕周正常胎儿心脏解剖结构及血流动力学情况的正常参考值范围。方法 采用节段分析法对203胎中孕期(21~25周)正常妊娠单胎胎儿行超声心动图检查,测定心脏房室、肺动脉、主动脉、动脉导管内径及房室瓣血流速度、半月瓣血流速度、动脉导管血流速度及静脉导管血流速度。对各测量值与孕周行直线回归分析。结果 ①心脏各房室、大血管及动脉导管内径随孕周增加而增大;②肺动脉与升主动脉内径比值不随孕周改变;③房室瓣口血流峰值流速不随孕周改变;④三尖瓣及二尖瓣血流A峰大于E峰;⑤半月瓣口、动脉导管、静脉导管血流峰值流速随孕周增加而增大。结论 建立21~25孕周胎儿心血管各结构内径及血流动力学的正常参考值范围,可为筛查胎儿先天性心脏病提供参考。     

胎儿超声心动图血流动力学参数与孕龄的关系

目的 探讨孕20~34周正常胎儿各孕周心脏房室瓣口、大动脉瓣口、胎儿静脉系统及重要生理通道的血流峰值速度随孕龄增长的变化规律。方法 回顾性分析2529名孕龄20~34周的正常单胎胎儿超声心动图资料,应用回归分析检测各参数与孕龄的相关性。结果 正常胎儿二尖瓣口和三尖瓣口舒张早期E峰、舒张晚期A峰和E峰/A峰,主动脉瓣口和肺动脉瓣口收缩期峰值流速,主动脉弓横弓部和动脉导管收缩期峰值流速和舒张期峰值流速,肺静脉左心房开口处收缩期S峰、舒张期D峰和心房收缩期A峰均随孕周增加略有增加;下腔静脉收缩期S峰、舒张期D峰及心房收缩期A峰无明显变化。上述胎儿血流动力学参数均与孕周存在相关关系(P均<0.05)。结论 胎儿超声心动图技术可评价心脏血流动力学状态,为胎儿超声心动图检查提供指导。     

正常胎儿心脏发育与孕周增长关系的初步探讨

目的 初步探讨二维超声心动图在研究胎儿心脏发育与孕周增长关系中的应用价值.方法 回顾分析386例正常胎儿超声心动图测值,统计胎儿心脏横径、左右房室横径、主动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速,以及心率随孕周变化增长的关系,分析正常胎儿心脏发育趋势;比较胎儿左右房室大小.结果 ①胎儿心脏横径、左右房室横径、主动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速与孕周之间均呈线性相关关系,随孕周增长而增长,心脏横径与孕周间的线性相关性最大,动脉导管舒张期流速受孕周影响最小;胎心率与孕周无明显线性相关;②右心系统横径大于左心系统横径,右心房横径与左心房横径,右心室横径与左心室横径间比较差异有统计学意义;③心脏横径/孕周比值及心脏横径/胸廓横径比值均呈正态分布,前者均数为0.95,接近1.0;后者均数0.44,小于0.5.结论 二维超声心动图可作为评估胎儿心脏发育的检测方法.     

卵巢囊腺瘤的CT诊断

研究背景 胎儿超声心动图作为一种对胎儿及母体均无创伤的检查方法在临床逐渐得到推广应用。妊娠期母体合并症及胎儿畸形均可引起胎儿形态、发育及血流动力学改变。明确不同孕周正常胎儿的生长发育状态及血流动力学特点对发现胎儿期异常变化意义重大。目的 本研究通过对正常胎儿心脏径线及血流速度与孕周关系的研究,初步探讨应用二维超声心动图研究胎儿心脏发育趋势及其临床价值。方法 回顾性分析386例经二维超声心动图检查获得的胎儿心脏测量数据,统计分析心脏横径、左右房室横径、主动脉内径、肺动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速随孕周变化关系,分析正常胎儿心脏发育趋势,比较胎儿左右房室大小。结果 ①除胎心率与孕周无明显线性相关外,其他参数与孕周之间均呈线性正相关,随孕周增长而增大;心脏横径与孕周间的线性相关最明显,动脉导管舒张期流速受孕周影响最不明显;②右心房横径与左心房横径、右心室横径与左心室横径间差异有统计学意义,右心系统横径大于左心系统横径;③心脏横径/孕周比值均数为0.9562±0.1426,接近1.0。心脏横径/胸廓横径均数为0.4769±0.3023,接近0.5。结论 二维超声心动图可作为胎儿心脏发育评估的手段。随着胎儿超声心动技术的逐步开展应用,超声影像技术的不断发展,对胎儿心脏发育与血流动力学变化的研究将越来越深入,胎儿超声心动技术应用也将越来越广泛。     

超声诊断胎儿法洛四联症伴肺动脉瓣缺如1例

孕妇,30岁.孕1产0,孕28周.胎儿超声心动图示:四腔心不对称,右心室轻度增大,室间隔上段缺损6 mm,主动脉与肺动脉位置关系正常,主动脉内径6 mm,骑跨于室间隔上,肺动脉呈瘤样扩张,内径约11 mm,右室流出道切面显示右室流出道无狭窄,肺动脉瓣环明显狭窄,无肺动脉瓣叶回声及启闭活动,彩色多普勒血流显像示肺动脉瓣口呈全收缩期湍流频谱及全舒张期反流血流,连续多普勒显示肺动脉瓣口呈连续双向射流与反流频谱,三尖瓣口显示少量反流血流,未能显示动脉导管血流.     

产前超声诊断胎儿卵圆孔血流受限或提前闭合的临床价值

目的探讨超声心动图诊断孕中晚期胎儿卵圆孔血流受限或提前闭合(FO-R/C)的临床应用价值。方法总结11例胎儿FO-R/C(病例组)的超声影像资料及妊娠结局,测量心胸比、各心腔大小、主动脉及主肺动脉内径和肺动脉瓣上及主动脉瓣上血流速度,并将结果与11例正常胎儿(正常对照组)进行比较。结果病例组中8例胎儿卵圆孔内径3 mm,3例卵圆孔近闭合;11例均测及三尖瓣反流,其中4例少量心包腔积液,1例心包腔合并腹腔积液。正常组与病例组右室与左室内径比值、右房与左房内径比值、主肺动脉/主动脉内径比值、肺动脉瓣上/主动脉瓣上血流速度比值及心胸比差异均有统计学意义(均P0.05)。病例组6例胎儿于孕38周剖宫产提前分娩,5例胎儿在超声心动图密切随访下足月分娩。出生后随访至4个月,心脏各腔室及比例均正常,6例三尖瓣反流消失,5例三尖瓣轻度反流。结论超声心动图诊断胎儿FO-R/C可为临床确定其分娩时间及分娩方式提供参考,对提高FO-R/C胎儿存活率及预后具有重要价值。     

正常胎儿出生前后心脏功能变化的分析

目的：探讨胎儿出生前后左右心室收缩及舒张功能的变化。资料与方法：本文分析５０例正常妊娠胎儿２０～４０周左右心室房室瓣口舒张期血流的Ａ／Ｅ比值及主、肺动脉瓣口血流速度的变化，同时比较１４例足月妊娠与４１例出生后新生儿的左右心室舒张收缩功能变化。结果：正常妊娠时，随孕周的增加左右心室房室瓣口血流速度Ａ／Ｅ比值逐渐降低，主动脉及肺动脉瓣口收缩期血流峰速逐渐增加。胎儿出生后左心室舒张期房室瓣口血流速度Ａ／Ｅ比值明显下降，主动脉瓣口血流峰速明显增快；右心室房室瓣口血流及肺动脉瓣口血流速度无明显变化。结论：正常妊娠期左右心室的舒张功能及收缩功能随孕周增加逐渐加强，胎儿出生后左心室舒张功能及收缩功能明显加强，而右心室舒张功能及收缩功能无变化。     

胎儿肺动脉瓣缺如综合征产前超声诊断分析

目的：总结胎儿肺动脉瓣缺如综合征产前超声图像特征。方法对2010年1月至2014年1月四川大学华西第二医院产前超声诊断并经尸解证实的5例肺动脉瓣缺如综合征胎儿超声心动图表现进行总结分析,观察胎儿心脏四腔观（4CH）、左心室流出道观（LVOT）、右心室流出道观（RVOT）、三血管气管观（3VT）各个常规切面观二维超声、彩色多普勒血流成像（CDFI）及脉冲多普勒血流流速曲线特征。结果5例肺动脉瓣缺如综合征胎儿中3例超声心动图表现为典型的肺动脉瓣缺如综合征征象：（1）肺动脉主干呈瘤样扩张且瓣环处狭窄。（2）在心脏搏动周期内,肺动脉内见红蓝交替的往返血流信号。（3）频谱多普勒示肺动脉内呈双期双向血流流速曲线,收缩期前向血流与舒张期反向血流速度、流速曲线宽度等均相似,血流速度无明显增加。5例胎儿中2例无肺动脉瓣缺如综合征肺动脉主干瘤样扩张特征性征象,其中1例胎儿肺动脉瓣缺如伴三尖瓣闭锁,右心发育不良,肺动脉主干无瘤样扩张,反而狭窄。1例胎儿肺动脉瓣缺如伴三尖瓣下移畸形,肺动脉主干虽扩张,但无瘤样扩张。结论胎儿肺动脉瓣缺如产前超声多有特征性表现,易于诊断,对无特征性肺动脉主干瘤样扩张征象肺动脉瓣缺如综合征胎儿,重视对肺动脉瓣口彩色多普勒血流信号及血流流速曲线的观察有助于正确诊断。     

超声心动图对胎儿心脏强回声结构的检测及其心功能评价

目的 探讨超声心动图检测胎儿心脏强回声结构(intracardiac hyperechogenic focus,ICEF)及对ICEF胎儿心功能评价的临床意义.方法 采用胎儿超声心动图对1291例孕22～40周胎儿进行检测,对检出的ICEF胎儿测量心脏大小及室壁厚度,定量主动脉瓣口、肺动脉瓣口、房室瓣口血流速度,测量房室瓣环舒张早期、舒张晚期及收缩期运动的峰值速度(Em、Am、Sm);随机选择128例正常胎儿作为对照组并测量相关参数;比较单纯ICEF胎儿与正常胎儿间的心脏收缩及舒张功能参数.结果 共检出ICEF胎儿448例,检出率34.7%(448/1291),其中伴先天性心血管畸形24例(5.4%),轻度三尖瓣反流24例(5.4%),染色体异常1例(0.22%).399例单纯ICEF胎儿与正常胎儿之间比较,二维及M型超声心动图所测心脏大小及室壁厚度等参数差异均无统计学意义(P＞0.05),单纯性ICEF胎儿与正常胎儿之间比较,主动脉瓣口、肺动脉瓣口、房室瓣口血流流速曲线及房室瓣环运动速度参数差异均无统计学意义(P＞0.05).结论 单纯性的ICEF胎儿伴发染色体异常的几率较低,并不伴明显血流动力学改变.     

Fetal pulmonary venous flow into the left atrium relative to diastolic and systolic cardiac time intervals.

OBJECTIVE: To establish the nature and gestational age dependency of the pulmonary venous flow velocity pattern into the left atrium relative to systolic and diastolic phases of the cardiac cycle. DESIGN: This was a cross-sectional study of Doppler measurements of fetal pulmonary venous inflow velocities, which were correlated with simultaneous recordings of transmitral and aortic flow velocity waveforms based on an equal cardiac cycle length (+/- 5%). RESULTS: Successful recordings were obtained in 28 out of 60 (47%) normal singleton pregnancies at 20-36 weeks of gestation. Reproducibility of waveform analysis of the various phases of the cardiac cycle was satisfactory, within-patient variance ranging between 1.7% and 6.5%. A statistically significant increase (p < 0.05) in pulmonary venous time average velocity and velocity integral with advancing gestational age was established. A statistically significant increase (p < 0.05) of the pulmonary flow velocity integral was also found when related to each of the systolic and diastolic segments of the cardiac cycle, with the exception of isovolemic relaxation time. The duration of each of the diastolic and systolic segments of the cardiac cycle, as well as the pulmonary venous velocity integral expressed as a percentage of the cardiac cycle, remained constant with advancing gestational age. CONCLUSIONS: The second half of pregnancy is characterized by pulmonary venous inflow into the left atrium throughout the cardiac cycle. Pulmonary venous inflow into the left atrium occurs predominantly during the filling and ejection phases of the cardiac cycle. Absolute cardiac diastolic and systolic time intervals as well as the percentage distribution of pulmonary venous flow velocity integrals between these cardiac time intervals remain unchanged with advancing gestational age.     

彩色多普勒超声监测生长迟缓胎儿脐动脉血液循环的变化

目的 应用彩色多普勒超声监测生长迟缓（IUGR）胎儿的脐动脉血液循环。方法 测定130例妊娠20－42周妇女（其中正常49例,IUGR81例）脐动脉时间平均血流速度（TAMX）,收缩期最大血流速度与舒张末期血流速度的比值（S／D）,搏动指数（PI）,阻力指数（RI）,收缩期最大血流速度（Vmax)与舒张末期血流速度（Vmin)。结果 正常孕妇随孕龄增长,胎盘功能增强,胎儿血液循环日渐丰富,IUGR者则明显障碍,在20周时脐动脉TAMX显著下降,在30周后S／D,PI及RI显著升高,Vmin显著下降,在35周时Vmax显著下降,出现舒张期血流停止或倒流。结论 彩色多普勒超声可直接测定脐动脉血流循环,能在早期诊断UGR,判断病情及估计预后。     

中晚孕期正常胎儿静脉导管血流动力学研究

目的 建立中晚孕期正常胎儿静脉导管多普勒血流参数参考范围。方法 应用彩色多普勒超声检查138例16-41孕周正常单胎胎儿。在静脉导管入口处记录静脉导管血流波形，测定血流参数包括：心室收缩期峰值流速（S）、心室舒张期峰值流速（D）、心房收缩期最大流速（A）、平均流速（Vmean）、S／A值、S／D值、（S-A）／S值、（S-A）／D值和（S-A）／Vmean值。结果 正常胎儿静脉导管的血流参数S、D、A、Vmean随着孕龄的增加而增加（均P〈0．01或P〈0．05）；而S／A、（S-A）／S、（S-A）／Vmean和（S-A）／D值随着孕龄增加而减低（均P〈0．01或P〈0．05），S／D与孕龄相关性差（r=0．1，P〉0．05）。结论 正常胎儿静脉导管血流波形呈特殊的三相波形，血流速度随着孕龄增加而增加，而阻力指数随着孕龄增加而减低，S／D值在妊娠中持续不变。     

正常胎儿主肺动脉多普勒参数与孕周的关系

目的探讨正常胎儿妊娠中、晚期主肺动脉多普勒参数与孕周的关系。 方法将孕龄为21~40周的正常胎儿300例按照孕龄分为10组,分别为21~22^＋6周、23~24^＋6周、25~26^＋6周、27~28^＋6周、29~30^＋6、31~32^＋6周、33~34^＋6周、35~36^＋6周、37~38^＋6周和39~40^＋6周,每组30例。采用彩色超声仪测量收集正常胎儿主肺动脉多普勒参数：收缩期加速度时间（AT）、射血时间（ET）、收缩期峰值流速（PSV）、舒张期末流速（EDV）、平均流速（MV）、搏动指数（PI）和阻力指数（RI）。建立不同孕周主肺动脉多普勒参数的正常参考值,对各参数值和孕周进行相关和回归分析。 结果300例胎儿均获得满意的主肺动脉流速曲线,AT、AT/ET、PSV、EDV和MV与孕周呈线性正相关（r=0.866、0.848、0.457、0.242、0.506,P均<0.05）;PI与孕周呈线性负相关（r=-0.170,P<0.05）;ET、RI与孕周无相关性（r=0.195、-0.197,P均>0.05）。 结论正常胎儿主肺动脉多普勒参数与孕周有一定的相关性,AT、AT/ET与胎儿孕周相关性最好。     

Blood flow velocity waveforms of the fetal pulmonary artery and the ductus arteriosus: reference ranges from 13 weeks to term.

OBJECTIVE: To establish reference ranges for blood flow velocity waveforms of the fetal main pulmonary artery and the ductus arteriosus during the second and third trimesters of pregnancy. METHODS: A prospective cross-sectional echocardiographic study was performed in 222 normal fetuses from 13 to 41 weeks of gestation using high resolution/color Doppler ultrasound equipment. RESULTS: Gestational age-specific reference ranges are given for peak velocity across the pulmonary valve, velocities in the ductus arteriosus, peak systolic velocity in the ductus arteriosus-to-peak velocity across the pulmonary valve ratio, ductal systolic velocity-to-diastolic velocity ratio, ductal resistance index and ductal pulsatility index. In the ductus arteriosus, increasing fetal heart rate was significantly associated with increasing end-diastolic velocity and decreasing systolic-to-diastolic ratio, decreasing resistance index, and decreasing pulsatility index. CONCLUSIONS: Based on a prospective study in more than 200 normal fetuses, the data provide gestational age specific reference ranges for blood flow velocity waveforms of the fetal pulmonary artery and the ductus arteriosus. The reference ranges may be helpful in prenatal diagnosis of cardiac malformations and ductal obstruction from 13 to 41 weeks of gestation.     

Inability of color and spectral Doppler to identify fetal renal obstruction.

Color flow Doppler imaging was used to obtain fetal renal artery flow velocity waveforms in 130 normal fetuses at various gestational ages to build a database for the establishment of normal ranges for the Pulsatility Index in the fetal renal arteries throughout pregnancy. Twenty-nine cases of fetal renal tract dilation (greater than 5 mm anteroposterior diameter of the renal pelvis) of various causes were investigated. We found that measurements of the pulsatility index were not significantly altered from the normal range, so that color flow Doppler does not appear to be helpful in the differential diagnosis of fetal renal dilation.     

Human fetal pulmonary artery velocimetry: repeatability and normal values with emphasis on middle and distal pulmonary vessels.

OBJECTIVES: To establish the nature and gestational age dependency of flow velocity waveforms from fetal middle and distal arterial pulmonary branches in the second half of normal pregnancy and to determine repeatability and inter-relationship of flow velocity waveform recordings from proximal, middle and distal arterial pulmonary branches. DESIGN: Cross-sectional study. SUBJECTS/METHODS: A total of 111 singleton normal pregnancies between 20 and 40 weeks of gestation were studied using a color-coded Doppler ultrasound system. Pulmonary waveforms were obtained at the level of the fetal cardiac four-chamber view. Repeatability was tested from two recordings at 15 min time-intervals in 25 separate normal pregnancies. RESULTS: Acceptable repeatability of flow velocity waveforms from fetal arterial pulmonary branches was established with coefficients of variation below 15%. The nature of middle arterial pulmonary flow velocity waveforms was similar to that of proximal waveforms and showed a gestational age-related change for diastolic velocity parameters, peak systolic/peak diastolic ratio and pulsatility index. The distal arterial pulmonary branch displayed a monophasic forward flow velocity profile throughout the cardiac cycle. All velocity parameters of the distal branch remained unchanged with advancing gestation, with the exception of the pulsatility index. Significant inter-pulmonary changes were found for all pulmonary arterial waveform parameters. CONCLUSIONS: Alteration in pulmonary vascular resistance may play a role in gestational age-related changes, whereas changes in vessel branching/diameter and in the distance between the heart and more distal arterial pulmonary vessels may cause inter-pulmonary differences.     

超声观察正常胎儿肾动脉的血流动力学参数及其临床价值

目的以彩色多普勒超声观察不同孕周胎儿肾动脉(RA)收缩期峰值血流速度(Vmax)、舒张期最低血流速度(Vmin)及搏动指数(PI)、阻力指数(RI),确定其正常参考值,分析其与孕龄的相关性。方法从接受常规产前超声检查的18～40周孕妇中选取符合条件的2627名进入样本库,测量胎儿肾动脉Vmax、Vmin和PI、RI,最后按孕龄分组,并进行统计学处理。结果胎儿左、右侧肾动脉血流Vmax(r=0.75,0.75)、Vmin(r=0.62,0.60)与孕龄呈正相关(P均<0.05),RI、PI随孕龄增长而呈缓慢下降趋势,仅在妊娠末期略有回升;胎儿左、右肾各血流参数测值间差异无统计学意义(P>0.05)。结论胎儿肾动脉血流速度与孕龄呈正相关,而肾动脉RI、PI随孕龄变化幅度很小。胎儿肾动脉血流监测可作为预测和评估胎儿有无宫内缺氧的方法之一。     

彩色多普勒超声观察不同孕周正常胎儿动脉血流的价值

目的：探讨不同孕周胎儿肾动脉（RA）、脐动脉（UA）、大脑中动脉（MCA）血流参数的变化情况,确定正常胎儿RA、UA、MCA血流参考值,并分析RA、UA、MCA血流参数与孕龄的关系。方法选取2013年1～12月在该院行产前检查的185例孕周为4～41周的正常单胎孕妇为研究对象,采用彩色多普勒超声测量胎儿 RA、UA、MCA的阻力指数（RI）、搏动指数（PI）、收缩期峰值流速（PS）及收缩期峰值流速与舒张末期流速比值（S/D）。结果随着孕周的增加,胎儿RA、UA、MCA中PS值显著增加,而RA、UA中RI、PI、S/D值显著减少。经相关性分析可知,RA、UA、MCA中RI、PI、S/D与孕周呈负相关性（P＜0．05）,而RA、UA、MCA中PS与孕周呈正相关性（P＜0．05）。结论应用彩色多普勒测量不同孕周胎儿RA、UA、MCA血流动力学参数能有效了解胎儿颅脑循环、胎盘循环及全身血流循环状态。通过建立正常胎儿血流参数参考范围可为超声预测胎儿宫内生长情况提供参考依据。     

Normal cardiac flow velocities at 14-16 weeks of gestation measured by transvaginal ultrasound.

OBJECTIVE: Doppler ultrasound has been used to study the flow velocities through the valves and arteries of the fetal heart. Using transvaginal sonography, we sought to determine normal values for flow velocities through the fetal heart valves at 14-16 weeks of gestation. METHODS: Eighty-seven normal fetuses were examined. The flow velocity waveforms were visualized using Doppler ultrasound with the sample volume calipers placed just distally to the four fetal valves. Peak E- and A-wave velocities were recorded for the tricuspid and mitral valves and peak systolic flow velocities were recorded for the ascending aorta and pulmonary arteries. Linear regression for comparison of flow velocities with gestational age was performed. RESULTS: There was no significant correlation between any of the velocities and gestational age. CONCLUSIONS: Flow velocities through the fetal cardiac valves remain unchanged at 14-16 weeks of gestation as measured by transvaginal Doppler sonography.