重视胎儿超声心动图检查的适应证和安全性

先天性心脏病(以下简称先心病)是最常见的重症先天性畸形,活婴先天性心血管畸形的发生率为0.8%～1.0%[1-2],简单畸形出生后可以通过外科手术进行矫治,而约50%的复杂畸形通过目前的治疗手段难以完全矫治,甚至相当一部分患儿在新生儿期就夭折.为了减轻胎儿复杂先天性心脏畸形出生后给自身带来的痛苦、给家庭和社会带来的经济负担,产前正确诊断胎儿心脏复杂畸形尤为重要.     

胎儿超声心动图检测胎儿房性期前收缩的临床研究

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。     

胎儿先天性心血管畸形的超声心动图分析诊断方法

心血管畸形是常见的先天性畸形,在存活的新生儿中心血管畸形的发生率为0.5%～1%[1,2],而出生的死婴中发生率高达3%[2,3].影响胎儿心血管发育的因素较多,包括环境因素、母体及胎儿方面的因素等.     

胎儿超声心动图检查规范——美国超声心动图学会指南解读

超声心动图是诊断胎儿先天性心脏病的首选技术手段。规范化的胎儿心脏超声心动图检查技术要求和检查流程,将有助于更为可靠准确的诊断各种胎儿先天性心脏畸形,同时保障胎儿安全。     

基层医院开展胎儿超声心动图筛查的作用分析

目的:探讨基层医院开展胎儿超声心动图筛查的作用.方法:选取2017年1月—2019年6月在北京市昌平区妇幼保健院建档并进行胎儿超声心动图筛查的孕妇10763例,其中10117例产后行新生儿超声心动图筛查,对产前检查出心脏异常病例转诊,与产前诊断机构诊断结果、生后新生儿超声心动图筛查结果、尸检及手术结果进行对比,并对常规...     

胎儿超声心动图对胎儿心脏内强回声结构的观察及其临床意义

国外研究显示绝大多数胎儿心脏内强回声结构是胎儿期常规产科检查所见的一种正常变异，但也有报道认为与胎儿染色体异常有关。本研究旨在探讨超声心动图对胎儿心脏内强回声结构的观察研究的临床意义。     

胎儿超声心动图的研究进展

胎儿心脏畸形是导致胎儿出生后死亡的主要原因,通过多种超声技术对胎儿心脏结构畸形、宫内心律失常以及心功能不全等检查评估,有效提高胎儿心脏畸形的诊断率,为早期临床治疗工作开展提供相应的依据,改善预后,对提升出生人口整体素质有着重要意义。胎儿超声心动图可以很好地观察胎儿心脏畸形具体结构、血流动力学的变化情况及病变具体变化过程。     

胎儿超声心动图进展

随着超声诊断技术的发展，胎儿超声心动图(Fetal echocardiography)诊断技术已有了很大的提高。其通过二维、三维、M型、血流多普勒、组织多普勒等成像手段，观察胎儿的解剖结构及其功能状况，且具有方便、有效、安全、价廉等优点。本文就近年的相关文献作简要综述。     

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。     

超声心动图在产前诊断胎儿先心病中的价值

目的：探讨超声心动图在产前诊断胎儿先心病中的价值。方法：应用超声心动图对孕16～40周的胎儿心脏进行检查。结果：在356例胎儿中发现先心病25例，占7．02％。23例证实与诊断结果相符，诊断正确率为92％；假阳性2例，假阳性率0．6％0；漏诊4例，漏诊率14．8％。结论：超声心动图对产前诊断胎儿先心病具有重要的临床价值且是其首选诊断方法。     

磁共振成像对复杂型先天性心脏病的诊断价值

目的评价磁共振成像（MRI）对复杂型先天性心脏病的诊断价值。方法对2l例复杂型先天性心脏病患者的MRI资料进行诊断分析,记录心血管畸形数目,以外科术后诊断（17例）或超声、心导管与心脏CT两种或以上检查的一致诊断（4例）作为参考标准,评估其诊断价值。结果2l例患者共63个主要心脏大血管异常,MRI检出61个,正确诊断率为96．8％（61／63）;误诊3个,分别为：漏诊房间隔缺损、主要体肺动脉侧支各1个和动脉导管残端误诊为动脉导管未闭1个。结论MRI对复杂型先天性心脏病正确诊断率高,可以作为心脏超声检查的重要补充检查手段。     

256层CT在复杂型先天性心脏病诊断中的应用

目的：探讨256层CT对复杂型先天性心脏病的临床应用价值.方法：回顾性分析59例先天性心脏病患者的256层CT扫描和心彩超资料,与手术和DSA结果进行对照分析.结果：59例经手术或DSA证实的心内、外结构异常共267个,其中心内结构异常132个,心脏与大血管连接部位异常24个,心外大血管异常111个.256层CT和心彩超对心内结构畸形的诊断符合率分别为70.45％和96.97％,差异有显著性意义（P＜0.05）;对心脏与大血管连接部分畸形的诊断符合率分别为91.67％和95.83％,差异无显著性意义（P＞0.05）;对心外大血管畸形的诊断符合率分别为93.69％和74.77％,差异有显著性意义（P＜0.05）;对先天性心脏病总的诊断符合率分别为82.02％和87.64％,差异无显著性意义（P＞0.05）.结论：256层CT对心外大血管畸形的诊断优于心彩超,256层CT和心彩超结合更有利于改善复杂型先天性心脏病的术前无创性评估.     

X线胸片诊断常见先天性心脏病

20世纪70年代以来,随着超声、CT、MRI广泛应用于临床检查,医学影像学的诊断技术发生了巨大变化,但迄今X线胸片仍作为简便、易行、有效的检查方法而广泛应用,包括在心血管疾病的诊断方面. X线胸部平片(胸片)能显示心脏整体及各房室、大血管的大小、形态和位置的变化及其程度,结合透视还可观察心脏、大血管的搏动等运动功能状态,同时可以反映继发于心血管疾患的肺循环障碍,如肺动、静脉高压的改变和程度,为诊断和评估预后提供重要的依据,在这方面是目前任何其他医学影像学手段都无法替代的检查方法.由于检查方法已规范化,胸片还被用为心血管病外科诊断和手术治疗前后的随诊观察方法.     

新生儿危重先天性心脏病围生期诊断和治疗的关键技术及其临床应用

目的总结新生儿危重型先天性心脏病(简称先心病)诊断和治疗关键技术在临床应用的经验。方法 2006年1月至2010年12月,新生儿患者369例,平均年龄13.4d,平均体重3.6kg。其中完全性大动脉错位(TGA)310例,完全性肺静脉异位引流(TAPVD)34例,室间隔完整性肺动脉闭锁(PA/IVS)25例。关键技术包括:改进合并冠状动脉畸形TGA的冠状动脉移植方法、改变心上型TAPVD的手术径路、改良PA/IVS的治疗模式;建立胎儿心脏超声,胎儿心脏磁共振诊断技术;健全新生儿围手术期未成熟脏器保护技术。结果 19例TGA合并冠状动脉畸形,大动脉掉转术后因心律失常死亡4例(死亡率21%)。其余291例TGA行大动脉掉转术后因严重低心排血量症死亡7例(死亡率2.4%);心上型TAPVD术后无严重心律失常发生率。PA/IVS心内外科镶嵌治疗组12例,术后因出血死亡1例(死亡率8.3%)。单纯手术治疗组13例,术后因心力衰竭、猝死4例(死亡率31%)。胎儿先心病确诊率由2006年前的70%提高至2010年95%。2004～2010年新生儿心脏术后神经系统并发症如抽搐、手足徐动症的发生率从6%降至0,严重低心排血量综合征发生率从11%降至5%,术后总体死亡率从15%降至4.0%。结论新生儿心脏手术的成功开展,需要有先进的治疗理念、治疗技术及医疗团队。     

Heart rate variability following neonatal heart surgery for complex congenital heart disease

BACKGROUND: Altered cardiac autonomic control may play a role in the morbidity and mortality suffered by neonates who undergo surgery for complex congenital heart disease (CHD). The purpose of this study was to evaluate cardiac autonomic activity, as measured by spectral indices of heart rate variability (HRV), prior to and early after infant surgery for CHD and attempt to correlate HRV indices with clinical outcome. In addition, we assessed the hypothesis that single-ventricle physiology and surgical interruption of the great arteries negatively affects HRV. METHODS: Sixty neonates prospectively wore 24-hour Holter monitors at three time points: before and early after CHD surgery, and at 3- to 6-month follow-up. Standard spectral indices of HRV were measured. RESULTS: In the early postoperative time point, patients with single-ventricle physiology had lower low-frequency power (LF) compared to patients with two ventricles (P=0.040). Surgical interruption of the great arteries did not affect HRV in this cohort. For the entire cohort, LF (P=0.004) and high-frequency power (HF) (P<0.001) increased over the three time points, while LF/HF (P=0.119) did not significantly change. In the multivariable linear regression model, significant predictors of longer postoperative hospital stay included longer total support time (P=or<0.001), longer duration of inotrope support (P=0.012), elevated mean heart rate at postoperative time point (P=0.002), and lower LF/HF ratio at the postoperative time point (P=0.014). CONCLUSION: Patients with single-ventricle physiology have a significant physiologic reduction in LF in the early postoperative period compared to patients with two ventricles. Diminished cardiac autonomic control is associated with longer hospitalization following neonatal cardiac surgery.     

Prenatal diagnosis of congenital heart disease: the beginning

Congenital heart disease (CHD) is the most common life-threatening defect in the first month of life. Its incidence is 8 per 1000 live newborns. Fetal echocardiography is used to screen, diagnose, monitor, and treat congenital heart defects and rhythm abnormalities. Early and improved diagnosis can hopefully impact morbidity, mortality, and emotional well-being of the family. Over the past three decades, fetal echocardiography has evolved into a discipline whereby the diagnosis of congenital heart disease has improved survival and in utero interventions. Continued research, improved technology, and broadened expertise will hopefully allow the health care team to provide better outcomes.     

Magnetic resonance imaging of complex congenital heart disease

Current MR techniques enable both anatomical and functional evaluations of the heart. Although it is rarely used as a primary diagnostic tool in pediatric cardiology, it can be used as a valuable adjunct to echocardiography and angiography. MRI is particularly useful in clarification of morphology of complex congenital heart diseases. It is the most accurate method of determination of visceral and atrial situs. It is easy to evaluate the systemic and pulmonary venous connections that are very important for the Fontan type of operation, especially in patients with visceral heterotaxy. It facilitates demonstration of diminutive pulmonary arteries in patients with pulmonary atresia. It clearly demonstrates juxtaposition of the atrial appendages that is often missed by echocardiography. The anatomy of the twisted atrioventricular connections is much more clear in MRI than in echocardiography. It enables en face imaging of ventricular septal defect that provides a surgical view. We find en face imaging particularly helpful in patients with double inlet left ventricle and transposition of the great arteries where the size of the ventricular septal defect governs the blood flow into the aorta. It is often advantageous to echocardiography in defining the type of univentricular atrioventricular connections by demonstrating the position and topology of the rudimentary chamber in difficult cases. In double outlet right ventricle, the spatial relationship of the ventricular septal defect to the great arterial valves can be clearly defined by visualizing the ventricular septal defect and the outlet septum in the same imaging plane.     

In utero ultrasound diagnosis of congenital heart disease

Two hundred and one pregnancies considered at high risk for congenital heart disease (CHD) underwent fetal cross-sectional echocardiographic (CSE) examination. In 190 cases a structurally normal heart was correctly predicted; seven cases of CHD were identified, but in two of them the specific diagnosis was inaccurate. One false positive diagnosis of a small ventricular septal defect was made. There were three false negative diagnoses: two of ventricular septal defects and one of aortic coarctation. We conclude that severe heart malformations can be reliably identified or excluded by CSE in utero, but important anatomical details may be missed. Therefore, prognosis should be based only on the structures identified to multiple-scan planes.