超声心动图对胎儿先天性心脏结构异常的诊断价值

目的探讨超声心动图对胎儿先天性心脏结构异常诊断的价值.方法2004-01-2005-10江门市妇幼保健院对724例胎儿心脏进行了二维、M型、彩色多普勒血流显像检查.取胎儿四腔心切面,三血管平面,大血管短轴切面,左心室长轴切面,主动脉长轴切面,右室两腔切面等多切面检查.结果724例胎儿超声心动图检查中15例诊断胎儿先天性心脏结构异常,4例伴有多发畸形.13例进行了治疗性引产,其中9例均经尸解证实超声诊断结构,4例拒绝尸解;1例心包积液;1例超声诊断为卵圆孔增大,出生后复查心脏结构未见异常.709例产前超声心动图检查未发现异常者3例于出生后发现先天性心脏病.结论超声心动图对胎儿先天性心脏结构异常的诊断具有重要价值.四腔心切面、三血管平面是超声诊断先天性心脏结构异常最重要的切面.     

应用超声检测胎儿心脏异常110例分析

目的探讨各种超声检查方法检测胎儿心脏异常的可行性.方法应用二维超声心动图检测胎儿心脏四腔心切面、左右室流出道切面,观察胎儿心脏解剖结构,必要时作彩色多普勒血流追踪扫查;加用M型超声或多普勒超声心动图观察胎儿心脏传导系统.结果自1983年至1997年期间,应用超声检出胎儿心脏异常110例,其中胎儿心脏解剖结构异常13例,胎儿心脏传导系统异常95侧,心脏解剖结构异常伴传导系统异常2例.由二维超声心动图首先怀疑胎儿心脏解剖结构异常的有14例,占93.33%(14/15),诊断胎儿心脏传导系统异常的有62例,占63.92%(62/97);由二维超声心动图加用彩色多普勒确诊胎儿心脏解剖结构异常的有15例,占100%(15/15);由脉冲多普勒超声诊断胎儿心脏传导系统异常的有35例,占36.08%(35/97).结论产前超声常规应用中档超声仪可筛选大部分胎儿心脏异常,这更符合我国的国情,有助于我国优生事业的发展.     

三个心脏超声切面在常见先天性心脏病产前诊断中的作用

目的 探讨三个胎儿超声心动图标准切面：四腔心切面、五腔心切面、三血管平面在发现和诊断胎儿常见先天性心脏病中的作用及对于先天性心脏病产前筛查的意义。方法 回顾2003年5月至2004年7月胎儿心脏畸形各病例的心脏超声图像，记录每一病例三个超声切面（四腔心切面、五腔心切面、三血管平面）的彩色多普勒超声图像表现，分析并总结各切面异常表现的特点。结果 （1）研究共包括胎儿心脏畸形病例26例，疾病类型包括房室间隔缺损、单纯性室间隔缺损、单心室、单心房、左心发育不良综合征、法洛四联症、右心室双出口、纠正性／完全性大动脉转位、动脉单干、主动脉瓣狭窄、肥厚性心肌病（梗阻型）、心脏肿瘤。（2）各心脏畸形病例在这三个心脏超声切面的扫查中至少有1个切面显示异常。每一类心脏畸形在这三个切面图像上均有特征性表现。（3）所有病例中二维四腔心切面（常规产科筛查切面）显示异常的比例为73％，四腔心切面未显示异常的病例包括：完全性大血管转位3例、法洛四联症1例、右心室双出口1例、动脉单干1例、主动脉骑跨伴室间隔缺损1例。（4）各标准切面获得率分别为：96．2％、88．5％、84．6％。结论 （1）四腔心切面、五腔心切面、三血管平面这三个胎儿彩色多普勒心脏超声切面探查在各类胎儿常见的先天性心脏病超声产前检查与诊断中起重要的作用。（2）与运用单个二维四腔心切面探查比较，三个切面的探查方法可提高常见先天性心脏病，尤其是胎儿心脏锥干畸形的检出率。（3）三个切面探查操作较为简便，有望成为一项胎儿先天性心脏病的筛查方法。     

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。     

彩色多普勒超声在胎儿先天性心脏病诊断中的应用

先天性心脏病(先心病)是一类常见的先天性疾病。通常认为,人群发病率为0·8%,而在我国围生期发生率呈上升趋势[1]。随着超声设备和技术的不断更新和进步,以及心血管胚胎学等相关基础研究的不断深入和细化,使得对先心病的自然病史的认识扩展到了胎儿阶段。因此,在胎儿期诊断先心病成为可能。二维实时超声可以显示心内结构的解剖学信息,而不能提供心脏血流动力学的情况。而彩色多普勒的应用,可以弥补二维超声的不足,可以从一个独特的角度协助诊断先心病。本文就彩色多普勒超声在胎儿先心病诊断中的应用作一介绍。1彩色多普勒超声诊断技术彩色…     

胎儿右房增大原因超声诊断研究

目的探讨胎儿右房增大原因的超声诊断思路。方法回顾性分析2005年1月至2014年12月中国医科大学附属盛京医院产前诊断胎儿右房增大的225例病例资料,二维超声结合彩色多普勒扫查胎儿四腔心切面、左右室流出道切面、三血管切面及三血管-气管切面等横断面,扫查腔静脉长轴切面、主动脉弓切面及动脉导管弓切面等矢状面。采用节段分析法除外胎儿先天性心脏病。结果产前超声正确诊断139例(61.8%)胎儿右房生理性增大,11例(4.9%)胎儿三尖瓣下移畸形,21例(9.3%)右房前负荷增大相关畸形,41例(18.2%)右房后负荷增大相关畸形及11例(4.9%)不明原因右房增大。2例(0.9%)产前超声诊断为生理性右房增大的胎儿出生后右房仍大。结论胎儿心脏超声检查发现心脏房室腔改变时应考虑到其他病变所引起的继发改变,分析时应以心脏血流动力学改变为主线,按照节段分析法由内脏-心房水平、心室水平以及大动脉水平逐一分析,以明确真正病因所在。     

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     

《中国实用妇科与产科杂志》2005年第9期国家级继续医学教育试题

(A型题,答题卡见下页)1目前胎儿心血管超声检查的基本技术,不包括哪一项?A二维超声B彩色多普勒超声C频谱多普勒超声D三维超声EM型超声2彩色多普勒超声在胎儿先天性心脏病诊断中的应用,对血流的显像分析不能做到的是?A确定血流的有无B判断血流方向C鉴定血流类型D显示血管分布E对     

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。     

胎儿心血管超声检查

胎儿心血管超声检查２０００３０中国福利会国际和平妇幼保健院李丽蟾随着围产医学及超声技术的发展，胎儿心脏超声检查已受到越来越多的国内外学者的重视。尤其是近几年来，二维超声分辨率的提高和彩色多普勒技术的出现，更为临床检查胎儿心血管异常提供了有效的诊断依据...     

The value of spatiotemporal image correlation technique in the diagnosis of fetal ventricular septal defect

Objective

To investigate the value of spatiotemporal image correlation (STIC) technique in the ventricular septal defect diagnosis.

Methods

A total of 1,163 fetuses were enrolled in this study, diagnosed by fetal echocardiography and analyzed by STIC technique. We obtained effective STIC volumes from the fetus according to the Goncalves?? report, and judged fetal cardiac structure from STIC volume information again with a double-blind method. Another echocardiography was obtained during neonatal or infant period as follow-up.

Results

(1) As much as 1,062 cases were diagnosed to have normal fetal heart by fetal echocardiography, 43 cases had congenital heart disease without VSD, and 58 cases had VSD [21 cases (36.2%) were simple VSD and 37 cases (63.8%)were VSD with other heart malformation]. (2) Three fetal VSD cases (0.26%) were missed and one normal case was diagnosed as VSD after two-dimensional (2D) echocardiography. STIC technique corrected the diagnosis for two cases: one case of VSD after fetal 2D echocardiography was confirmed to be normal with STIC and neonatal heart examination; one case that was diagnosed as normal by fetal 2D echocardiography was confirmed to have VSD with STIC and neonatal heart examination.

Conclusions

The special value of STIC technique in the diagnosis of VSD had been confirmed by this study, and it had been proved as the best additional method to fetal echocardiography.     

Prenatal diagnosis of congenital heart malformations: classification based on abnormalities detected by the four-chamber view.

The aim of the study was to provide logical steps, alternative to the sequential chamber analysis, for diagnosing major congenital heart malformation prenatally. Between 1988 and 1995, of the 14,885 high-risk pregnancies screened at the Departments of Obstetrics and Paediatric Cardiology, University of Hong Kong, 92 fetuses with major congenital heart malformations were detected at 17-36 weeks' gestation (mean=24.6 weeks) by extended fetal echocardiographic screening. These were classified according to obvious abnormalities related to the partition of the heart or ventricular dimensions depicted by the four-chamber view. Subgrouping according to the presence of normal or abnormal ventriculo-arterial connection, with or without outflow tract anomalies, was further attempted. Five groups were identified: (1) septal defects with all four chambers identified (n=62, 67 per cent); (2) intact septation with dilatation of either the right or all four chambers of the heart (n=12, 13 per cent); (3) intact septation with hypoplasia of either one of the ventricles (n=11, 12 per cent); (4) a rudimentary interventricular septum giving an apparent three-chamber heart (n=6, 7 per cent); (5) miscellaneous causes (n=1, 1 per cent). Combined with the information related to the ventricular outflow tracts, the accuracy of arriving at a definitive diagnosis was 97 per cent, when compared with postnatal investigations, surgery and/or autopsies. This simple classification could provide logical steps to arrive at a definitive diagnosis for most major fetal heart malformations.     

HLHS--congenital heart defect in High Risk Pregnancy Unit in 2001-2007

BACKGROUND: HLHS (hypoplastic left heart syndrome) is a serious congenital heart defect. In neonates with congenital heart disease HLHS accounts for nearly 25% of neonatal deaths. The etiology of HLHS is unknown. At present we expect to have those cases diagnosed in the second trimester of pregnancy. AIM: The main aim was to find the rate and outcome of the congenital heart defect--left heart hypoplasia (HLHS). MATERIAL AND METHODS: All cases of this heart defect found in the High Risk Pregnancy Clinic in 2001-2007 were presented. Twice the congenital malformation was diagnosed after delivery and once during pregnancy--in the second trimester. All babies were delivered between 38 and 39 weeks of pregnancy, one by the spontaneous normal delivery, one by elective caesarean section and one by emergency caesarean section because of fetal distress during the delivery. All of the newborns were transported to the Pediatric Cardio surgery Unit of M.U. and operated in first weeks after delivery. RESULTS: In two cases the operation was complicated and children died due to the cardiac arrest. One of the babies died before surgical correction. Two of the women, whose babies died after the operation gave birth to healthy newborns with no cardiac abnormalities. CONCLUSION: The HLHS is the most serious heart congenital malformation diagnosed often after the delivery because of lack of sufficient diagnostic system in healthy women. The prognosis for the children is bad, but the chance of giving birth to healthy children in the future is good.     

Prenatal diagnosis of congenitally corrected transposition of the great arteries. A case report

Congenitally corrected transposition of the great arteries (CTGA) is an uncommon congenital cardiac anomaly. Prenatal sonographic diagnosis of CTGA is very difficult because the ventricular outflow tract may appear to arise correctly from the right and left ventricles. Few cases of CTGA diagnosed in utero have been reported. We report a case of CTGA with complete heart block, ventricular septal defect and pulmonary valve stenosis diagnosed at 30 weeks' gestation after the mother was referred to our hospital because of persistent fetal bradycardia.     

"胎儿心脏筛查指南"在产前超声筛查胎儿先天性心脏病中的应用价值

目的 探讨2006年国际妇产科超声协会公布的"胎儿心脏筛查指南"在产前超声筛查胎儿先天性心脏病中的应用价值.方法 2006年9月-2007年7月在南京大学医学院附属鼓楼医院母胎医学中心接受胎儿超声筛查的单胎孕妇5000例.平均年龄28岁(18～48岁),平均孕周27周(妊娠18～40周).以"胎儿心脏筛查指南"为标准对胎儿四腔心和左、右心事流出道及三血管切面进行扫查,对疑有心脏异常者进一步行胎儿超声心动图枪查,对确诊先天性心脏病胎儿建议羊水或脐血穿刺行染色体核型分析,终止妊娠者行胎儿尸体心脏解剖;继续妊娠者,于胎儿出生后2～6个月行超声心动图随访.结果 (1)超声筛查各切面获取率:5000例单胎孕妇中,四腔心切面获取率为97.64%(4882/5000),其中左、右心室流出道及三血管切面的获取率分别为87.69%(4281/4882)、82.51%(4028/4882)和96.29%(4701/4882).5000例孕妇中,孕中期筛查2750例,孕晚期筛查2250例,孕晚期各标准切面的获取率明显低于孕中期(P<0.05).(2)胎儿先天性心脏病发病率:4882例胎儿中最终诊断先大性心脏病73例,发病率为1.50%(73/4882),其中产前超声确诊50例(孕中期24例、孕晚期26例).超声漏诊23例,误诊1例,合并其他器官畸形18例.(3)随访结局:产前诊断为先天性心脏病的胎儿中接受尸体心脏解剖19例,均与产前超声诊断结果一致;继续妊娠者胎儿出生后接受超声心动图检查12例,其中与产前诊断符合11例,另1例产前诊断三尖瓣关闭不全,产后超声检查正常.接受染色体检查23例,染色体核型异常7例.(4)产前超声筛查的敏感性与特异性:四腔心切面确诊先天性心脏病胎儿28例,同时加入左、右心室流出道及三血管切面共诊断先天性心脏病50例,诊断的敏感性为69%(50/73)、特异性为99.98%(4808/4809),假阴性率为0.48%(23/4831),假阳性率为2%(1/51).结论 国际妇产科超声协会2006年公布的"胎儿心脏筛查指南"临床实用、易于遵循、便于操作.就最佳超声切面获得来说,孕中期(18～27周)是最佳筛查时间.胎儿四腔心和左、右心窒流出道及三血管切面同时筛查,可产前诊断69%的先天性心脏病胎儿.     

胎儿持续性心动过缓15例临床分析

Objective?To find out the common causes and prognosis of fetal persistent bradycardia. Methods?Retrospective analysis was performed on 15 cases of fetal bradycardia diagnosed by fetal echocardiography in Peking University First Hospital from January 2013 to January 2020. Results?① There were 3 cases of fetal bradycardia complicated with fetal heart malformation, All of them chose to terminate pregnancy.② There were 8 patients with atrioventricular block, the main cause of which was positive maternal serum autoantibody anti-Ro (SS-A) combined with anti-La (SS-B) in 5 cases. 4 cases delivery at term, permanent pacemakers were placed in 2 neonates. ③ There were 4 cases of fetal bradycardia with atrioventricular 1:1 conduction, all of which were delivered at term. Only one case was diagnosed as sick sinus syndrome after birth. Conclusion?Fetal heart malformation should be ruled out in fetal bradycardia, and atrioventricular block mainly caused by abnormal maternal autoantibodies. The long-term prognosis of fetal bradycardia is closely related to the etiology.     

The accuracy of antenatal fetal echocardiography screening in high- and low-risk patients

Objective: The purpose of this study was to evaluate the accuracy of four-chamber and left ventricular outflow tract views in low-risk patients and comprehensive fetal echocardiographic examinations in high-risk patients to diagnose structural heart disease or thoracic anomalies.Study design: A prospective outcome study of two cohorts was performed; 1136 low-risk patients and 886 high-risk patients were evaluated during a 2-year period. Low-risk patients had detailed fetal echocardiographic examinations. Accuracy of the ultrasonographic diagnosis was evaluated from neonatal discharge data.Results: Only 2 of 14 patients with congenital heart disease in the low-risk group were correctly identified (sensitivity 14.3%) whereas 10 of 16 patients with congenital heart disease or thoracic anomalies were correctly identified in the high-risk group (sensitivity 62.5%).Conclusion: The current study showed poor diagnostic accuracy of the standard four-chamber and left ventricular outflow tract views in low-risk patients for the diagnosis of structural cardiac anomalies. Patients with risk factors for congenital heart disease should be referred for comprehensive fetal echocardiographic examination.     

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.