胎儿心脏超声对室间隔缺损的诊断价值

目的 探讨产前胎儿心脏超声检查对室间隔缺损(ventricular septal defect,VSD)的诊断价值及局限性. 方法 2009年1月1日至2010月10月31日,在复旦大学附属妇产科医院进行系统产前检查的孕妇于妊娠20～24周进行胎儿心脏超声检查,产后48 h新生儿接受心脏超声检查;引产终止妊娠者行胎儿尸体解剖以明确心脏畸形的诊断,共纳入孕妇4392例(1例双胎妊娠,胎儿4393例).计算产前超声对于VSD的检出率及漏诊率. 结果 (1)复杂性VSD检出情况:产前胎儿心脏超声检查共检出23例复杂性VSD,其中1例合并部分性心内膜垫缺损,但产后新生儿心脏超声未见异常,另22例均引产终止妊娠,引产胎儿尸体解剖证实产前诊断.(2)单纯性VSD检出情况:产前胎儿心脏超声检出16例单纯性VSD,其中15例产后新生儿心脏超声未见异常,另1例产后新生儿心脏超声证实为单纯性VSD.(3)检出率:产前胎儿心脏超声检查中未检出VSD的4354例胎儿中,产后新生儿心脏超声检出54例VSD,均为单纯性.产前检出产后证实的及产后诊断的VSD共77例,发生率为1.8％ (77/4393),单纯性VSD发生率为1.3％(55/4393),复杂性VSD发生率为0.5％(22/4393).产前胎儿心脏超声检查对于复杂性VSD的检出率为100.0％(22/22),漏诊率为0.0％(0/22),误诊率为0.2‰(1/4371).产前单纯性VSD的检出率为1.8％(1/55),漏诊率较高(98.2％,54/55),误诊率为3.5‰(15/4338). 结论 产前胎儿心脏超声检查对于合并有其他心脏结构异常的复杂性VSD的检出率及准确率高;而对于单纯性VSD,有较高的漏诊率及误诊率.     

彩色多普勒超声心动图在房间隔缺损和室间隔缺损介入治疗中的应用

目的探讨经胸超声心动图(TTE)及实时三维超声心动图在房间隔缺损(ASD)、室间隔缺损(VSD)封堵术中的临床应用价值。 方法应用二维及三维超声心动图对2004 10—2005 10在天津市儿童医院就诊的24例继发孔ASD，10例VSD进行术前检查筛选，术中超声引导及术后随访检查。 结果24例ASD患儿术前经TTE检测ASD直径(15.6±7.9)mm(5~26mm)，所选Mmplatzer封堵器直径为(19.1±5.1)mm(5~32mm)，23例封堵成功。室间隔膜部缺损直径：左室面缺损为5~9mm，右室侧口的直径为2.4~6.0mm，术中选择Amplatzer封堵器型号为4~6mm，10例VSD无残余分流。 结论二维及三维TTE联合应用于ASD、VSD介入治疗具有很好的应用价值。     

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     

胎儿部分型及过渡型房室间隔缺损的产前超声诊断特点

目的 探讨产前超声诊断胎儿部分型及过渡型房室间隔缺损的价值。方法 回顾性分析11例经尸体解剖和产后超声心动图证实的部分型及过渡型房室间隔缺损胎儿的产前超声表现,总结其声像图特征。 结果胎儿超声心动图显示,7例部分型和4例过渡型房室间隔缺损在四腔心切面均显示原发孔型房间隔缺损,二尖瓣和三尖瓣在室间隔的附着点位于同一水平,关闭时与室间隔构成“T”字形图像。7例部分型房室间隔缺损中1例伴有左室-右房通道;4例过渡型房室间隔缺损均伴有室间隔上部缺损。11例胎儿中伴有二尖瓣反流4例,二、三尖瓣反流1例,双侧桡骨缺如1例。 结论产前超声观测心脏“T”字形声像图特征对诊断胎儿部分型和过渡型房室间隔缺损具有重要临床价值,但应注意与冠状静脉窦形成的假象鉴别。     

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。     

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。     

先天性心脏病介入治疗与传统外科手术治疗的临床比较

目的对房间隔缺损(ASD)、室间隔缺损(VSD)、动脉导管未闭(PDA)的介入治疗(Amplatzer封堵器)和外科手术治疗的临床疗效进行比较。 方法研究对象为2004 05—2005 05在北京安贞医院小儿心脏科住院患儿80例，符合单一左向右分流畸形ASD、VSD、PDA,根据治疗方法不同分为介入组(40例)和手术组(40例)；比较2组在疗效、费用、并发症、输血量及住院时间等方面的异同；通过放免法测定2组ASD及VSD治疗前后的心钠素(ANP)水平。 结果2组手术成功率均为100%；介入组均未输血,手术组均输血治疗；术后住院时间介入组少于手术组(P<0.01)；治疗费用介入组高于手术组(P<0.01)；ANP水平，外科手术及介入治疗后均较治疗前降低。 结论单一ASD、VSD、PDA的介入治疗与手术治疗临床效果相同；介入组不需输血,术后住院时间短,但治疗费用较昂贵。     

胎儿心脏畸形诊断中产前超声的应用价值

目的评价胎儿心脏畸形诊断中产前超声的应用价值。方法随机选择80例自2015年12月~2017年1月来本院妇产科例行产前检查的孕妇,所有孕妇均实施产前超声检查,根据超声图像分析胎儿心脏畸形诊断率。结果经产前超声检查后,73例胎儿心脏血流情况及形态均处于正常状态;7例胎儿出现心脏形态异常及血流异常现象。7例胎儿中有3例为三尖瓣闭锁、3例为完全性心内膜垫缺损、1例为单心房。对73例产前超声检查未出现异常的胎儿进行随访,随访率为100%(73/73),其中有2例胎儿出现漏诊,其中1例为心脏简单畸形、1例为动脉导管未闭。产前超声诊断准确率97.3%(71/73),经产前超声检查胎儿心脏畸形检出率8.8%(7/80),心脏畸形诊断准确率100%(7/7)。结论实施产前超声检查,对提高胎儿心脏畸形检出率具有较高的应用价值,值得临床推广应用。     

胎儿心内膜垫缺损的产前诊断及相关因素分析

目的探讨胎儿心内膜垫缺损畸形的产前诊断及相关因素。方法对北京大学人民医院2004年1月~2007年8月产前及产后诊断的先天性心脏畸形中18例心内膜垫缺损胎儿产前超声特征、合并心内、心外其他畸形及与染色体异常的相关性进行分析。结果18例产前诊断的胎儿心内膜垫缺损中,完全性心内膜垫缺损14例(77.8%);不完全性心内膜垫缺损4例(22.2%);合并内心畸形12例(66.7%),心外畸形8例(44.4%),未合并其他畸形2例(11.1%)。产前及产后共行染色体核型分析14例,诊断21-三体2例(14.3%),其余染色体核型正常。结论胎儿心内膜垫缺损畸形易合并心内大血管畸形及心外畸形,与21-三体有一定相关性,妊娠期以四腔心联合左右室流出道切面的心脏超声筛查法具有较高的诊断率,临床应重视单纯表现为心内膜垫缺损胎儿产前染色体检查的必要性。     

胎儿先天性心脏病产前超声筛查诊断模式的评价

目的 评价胎儿先天性心脏病产前超声筛查诊断模式.方法 收集2004年2月-2007年5月复旦大学附属妇产科医院产科在孕24周前行产前诊断的11 410例孕妇,应用超声筛查其11 544例胎儿的先天性心脏病发生情况.超声筛查切面包括四腔心切面、流出道切面(包括左室流出道+三血管切面),计算不同切面诊断先天性心脏病的敏感性及特异性,并随访胎儿预后.结果 (1)11 544例胎儿中,筛查出先天性心脏病48例,漏诊6例,先天性心脏病发生率为0.47%(54/11 544).(2)四腔心切面发现胎儿先天性心脏病33例,主要为室间隔缺损18例(其中9例合并锥干异常)、房室瓣膜异常6例及左、右心不对称9例.四腔心切面诊断先天性心脏病的敏感性为61.11%(33/54),特异性为99.98%(11 488/11 490).流出道切面诊断胎儿先天性心脏病15例,包括肺动脉闭锁1例,肺动脉瓣狭窄3例,大血管错位2例,肺动脉狭窄及大血管错位1例,法洛四联症6例,肺动脉狭窄2例.四腔心切面+流出道切面诊断胎儿先天性心脏病的敏感性为B8.89%(48/54),特异性99.98%(11 488/11 490).(3)48例先天性心脏病胎儿中,有11例合并其他器官系统异常,另有11例行羊膜腔穿刺检查胎儿染色体,其中5例为21三体.结论 四腔心切面+流出道切面对胎儿先天性心脏病的产前超声筛查有较高的检出率,此产前超声筛查诊断模式在临床上诊断胎儿先天性心脏病切实可行.     

新生儿双侧室间隔面积正常值及标化空间隔缺损分型

目的寻求适合新生儿室间隔缺损（简称室缺）的分型标准。方法建立摄像求积法,应用2000医学信号图象处理系统对74例非心脏病死亡的新生儿,10例成人心脏标本的双侧室间隔面积及高进行测量。以成人标准标化了新生儿室缺。结果获得两组新生儿室缺的标准。室缺直径标准：≤2kg组：小型空缺＜1．5mm,中型1．5～5．0mm,大型＞5．0mm;＞2kg组：小型室缺＜20mm,中型2.0～6.0mm,大型＞60mm。面积标准：≤2kg组小型室缺＜2.0mm2,中型2.0～20mm2,大型＞20mm2;＞2kg组：小室缺＜3．0mm2,中型3．0～30mm2,大型＞30mm2。结论本研究提出的室缺直径标准和面积标准适合我国新生儿。     

The Paravaginal Defect Repair

The paravaginal defect repair, first described by White in 1909,¹ restores the natural support of the vaginal fomices by reapproximating them to the arcus tendineus fascia pelvis overlying the levator and obturator internus muscles. Pelvic surgeons employing this surgical technique distinguish between cystocoele caused by attenuation or tearing of the pubocervical fascia (the midline defect) and cystocoele caused by detachment of the pubocervical fascia from its sidewaR support (the paravaginal defect).The paravaginal defect repair can be undertaken either through an abdominal or vaginal approach. Both procedures have been used to treat cystocoele and stress urinary incontinence with success rates that range from 66 to 97 percent. The postoperative morbidity associated with paravaginal repair, including urinary retention, detrusor instability, and recurrent pelvic prolapse, is reduced when compared to the traditional anterior colporrhaphy and retropubic incontinence procedures.Research efforts should focus on comparing the abdominal paravaginal repair to other established retropubic incontinence procedures. It may prove to be equally efficacious, while producing a decreased incidence of peri-operative morbidity. The vaginal paravaginal repair should permit a more comprehensive approach to cystocoele repair, while at the same time producing a higher cure rate of stress urinary incontinence than the needle suspension procedures.     

Atrial and ventricular septal defects – epidemiology and spontaneous closure

Objective.?To present data on the epidemiology and spontaneous closure for septal defects (secundum atrial septal defect (ASD) and/or ventricular septal defect (VSD)).

Methods.?Data from the EUROCAT Registry of Congenital Malformations for Funen County, Denmark were analyzed. All infants born from 1986 to 1998, diagnosed with a secundum ASD and/or a VSD as the only cardiac malformation, were included.

Results.?There were 78 infants with an ASD, 195 with a VSD, and 19 had both an ASD and a VSD. The overall prevalence of septal defects was 4.1 per 1000 livebirths. Among the VSDs 45% were perimembranous and 55% were muscular defects. Associated non-cardiac malformations, syndromes, or karyotype anomalies were present in 54 cases (19% of total) but with a significantly lower proportion among cases with muscular VSDs (7%, p < 0.05). Eighty-one percent of the cases had an isolated cardiac malformation. Five of 61 cases (8%) with isolated ASD were closed surgically before five years of age and 43 (70%) closed spontaneously within the first five years of life. Of the 65 cases with isolated perimembranous VSDs, 13 were closed surgically (20%) and 13 closed spontaneously (20%). Of the 99 cases with isolated muscular VSDs no defects were closed by surgery and 64 (65%) closed spontaneously. The rate of spontaneous closure for perimembranous and muscular VSDs were significantly different (p < 0.0001).

Conclusions.?Secundum ASD has a high rate of spontaneous closure. Perimembranous and muscular VSDs seem to be two different diseases with different epidemiology and natural history.     

新生儿双侧室间隔面积正常值及标化室间隔缺损分型

目的 寻求适合新生儿室间员的分型标准。方法 建立摄像求积法,应用２０００医学信号图像处理系统对７４例非心脏病死亡的新生儿,１０例成人心脏标本的双侧室间隔面积及高进行测量。以成人标准标化了新生儿室缺。结果 获得两组新生儿室的标准。室缺直径标准：≤２ｋｇ组：小型室缺〈１．５ｍｍ,中型１．５－５．０ｍｍ,大型〉５．０ｍｍ;〉２ｋｇ组;小型室缺〈２．０ｍｍ,中型２．０－６．０ｍｍ,大型〉６．０ｍｍdisplay     

圆锥动脉干畸形室间隔缺损的三维超声定量研究

目的 探讨三维超声心动图(3DE)在圆锥动脉干畸形(CTD)室间隔缺损(VSD)定量研究中的准确性及其临床意义。 方法 2000年5月至2003年11月在上海儿童医学中心住院且二维超声心动图(2DE)、经胸3DE、心血管造影及手术等定量测量结果完整的CTD患儿共63例，将3DE测量结果与2DE、造影及手术测值对比。 结果 方差分析、SNK均数间两两比较及相关分析显示，3DE VSD长径测值为1.69cm(从右室面)和1.63cm(从左室面)，虽较手术测值(1.84cm)低估，但低估程度小于2DE测值(1.27cm)及造影测值(1.12cm)；3DE与手术测值的相关性(r=0.74)明显高于2DE(r=0.39)及造影测值(r=0.25)。3DE VSD短径测值与造影测值相接近，两者比较无统计学差异(P＞0.05)。3DE VSD短径测值与2DE及造影测值的相关性(r=0.45，r=0.54)高于3DE VSD长径测值与2DE及造影测值的相关性(r=0.37，r=0.44)。3DE VSD面积测值与手术测值呈良好相关(r=0.57)。 结论 3DE可作为CTD VSD定量分析的又一无创手段，能提供较2DE更准确的定量诊断。 Abstract Objective To evaluate the accuracy and clinical value of transthoracic three dimensional echocardiographic (3DE) quantitative analysis in ventricular septal defect (VSD) of conotruncal defects (CTD).Methods From May 2000 to November 2003 in Shanghai Children Medical Center,there were 63 inpatients of CTD with all quantitative findings measured by 3DE,two dimensional echocardiography (2DE),angiocardiography and surgical findings.Their measurements of VSD sizes and areas with 3DE were compared with those with 2DE,angiocardiography and surgical findings.Results From the analysis of variance,Student Newman Keuls (SNK) test and correlation analysis,the measurements of VSD long diameter (mean 1.69cm in en face view of ventricular septa from right ventricle and 1.63 cm in en face view of ventricular septa from left ventricle) with 3DE was less than the measurements of VSD diameter (mean 1.84 cm) with surgical findings,but they were better correlated with those with surgical findings (r=0.74) than the measurements of VSD diameter (mean 1.27 cm) with 2DE (r=0.39) and those (mean 1.12 cm) with angiocardiography (r=0.25).However,the measurements of VSD short diameter with 3DE was close to those with angiocardiography,and there was no significant difference (P>0.05) between them.The measurements of VSD short diameter with 3DE were better correlated with those with 2DE and angiocardiography than the measurements of VSD long diameter with 3DE.Meanwhile,the measurements of VSD area with 3DE were well correlated with the measurements of VSD diameter with surgical findings (r=0.57).Conclusion 3DE can provide more accurate quantitative diagnosis in CTD VSD than 2DE. Key words Conotruncal defects;Three dimensional echocardiography;Two dimensional echocardiography;Ventricular septal defect     

Determination of Isthmocele Using a Foley Catheter During Laparoscopic Repair of Cesarean Scar Defect

Study Objective

To demonstrate a new technique of isthmocele repair via laparoscopic surgery.