超声检测胎儿严重先天性心脏畸形9例分析

目的 探讨二维超声心动图和彩色多普勒超声产前诊断胎儿先天性心脏畸形的可行性。方法 应用二维超声图像对胎儿心脏进行四腔切面,左室流出道,右室流出道切面等心脏解剖结构检查,加以彩色多普勒血液图对胎儿心脏进行血流方向及流速的观察。结果 １３５３９例被检孕妇中９例胎儿存在严重的先天性畸形,其中４例左心发育不良,２例肺动脉瓣狭窄,２例大血管转位,１例内脏反位,右心发育不全,均由病理尸解或新生儿心脏超声证实。     

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.     

胎儿心动图的临床应用研究

二维超声和多普勒心动图可准确检查胎儿心脏。宫内诊断胎儿心脏异常,有利于早期行宫内治疗和对孕妇进行必要的处理。作者在1985～1989年间对323例孕妇进行了338次超声检查,除1例经阴道外均经腹部探测。受检指征有:先心病(CHD)家族史;胰岛素依赖型糖尿病;胎儿心律异常;药物接触史;胎儿其他缺陷和产科超声怀疑CHD等。平均孕龄24周,超声探头朝向胎儿胸前和腹部是检测胎儿心脏影像的最好位置。孕20周是检测最好时机,足月后因羊水减少,胎儿位置变化受限和骨化增加而影响结果。产后随访260例新生儿,5例诊断错误。323例中,47例(15%)胎儿有异常发现。除外间断性房性心律失常,35例(11%)有明显异常。其结果除1例外均得到产后临床/心动图/导管     

胎儿心律不齐

胎儿心律不齐的发生率约为1%,其中10%可能为胎儿病率的原因。过去对人类胎儿心血管系统的研究是通过间接的方法,即:母亲感到的胎动、胎心率听诊及胎心电子监测。现用超声检查胎心的解剖与生理;应用二维超声可评价胎心解剖结构,M型超声心动图用于了解胎心律、室壁、心腔大小和心包积液;多普勒超声心动图可检测各心腔和血管的血流速度;彩色多普勒血流标测可检出血流障碍,采集胎儿血可测血细胞计数、血气、血化学及药物水平。一、正常和异常心律     

应用彩色多普勒四维超声诊断胎儿先天性心脏病

近几年发展起来的时间-空间相关成像技术(STIC)能静态或动态地显示胎儿心脏的容积图像,彩色多普勒血流显像与STIC相结合的四维重建可获取二维超声心动图所无法获得的胎儿心脏解剖及病理特点的某些信息,并且图像直观,有助于判断心内血流及心血管系统的空间位置关系~([1]).     

多普勒超声心动图用于胎儿心脏疾患方面的评价

近代经验证实,使用二维超声及二维指导下的M型超声技术可探查胎儿心脏的解剖及胎心律紊乱,是一种无害的检查法.因而对妊娠、分娩以及新生儿的特殊护理可预先作出适当安排.作者认为对儿童及成人心脏疾患的估计脉冲多普勒可增加二维和M型超声技术的可靠性.近有报道脉冲多普勒超声心动图应用于人胎儿心脏疾患及心室输出量的探查,作者曾报导用此种技术分析心脏内循环的血液动力学及心室输出量.本文介绍进一步使用脉冲多普勒超声波对胎儿心脏病的分析.所用的多普勒超声心动仪是将实时二维显象,M显象以及脉冲多普勒显象融为一体,探头     

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     

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...     

Fetal echocardiography: accuracy and limitations in a population at high and low risk for heart defects.

OBJECTIVE: Our objective was to assess the accuracy of prenatal echocardiography in detecting congenital heart defects in patients at high and low risk for structural cardiac anomalies. STUDY DESIGN: Sixty-nine consecutive fetuses with congenital heart defects who had had prenatal ultrasonography at greater than or equal to 18 weeks' gestation were evaluated to determine the accuracy of prenatal ultrasonography in identifying structural cardiac defects. Thirty-nine patients were at high risk and 30 patients were at low risk for cardiac anomalies. All fetuses were scanned with standard four-chamber and outflow tract views. Data concerning extracardiac anomalies and karyotypic abnormalities were tabulated. The accuracy of the four-chamber view alone in identifying congenital heart defects was evaluated. RESULTS: Fifty-seven of 69 fetuses (83%) were prenatally identified ultrasonographically as having a heart defect. There was no difference in the sensitivity of detecting cardiac anomalies between high-risk and low-risk groups. When the four-chamber view was used, only 63% of fetuses were recognized as having an abnormal heart. Extracardiac anomalies were noted in 36% and karyotypic abnormalities in 17% of patients. CONCLUSION: The four-chamber and outflow tract views done routinely in an ultrasonography laboratory seeing a mixed population of patients was successful in detecting 83% of fetuses with structural cardiac malformations. Because 43% of the fetuses with heart defects were referred for low-risk indications, systematic ultrasonographic examination of the fetal heart should not be reserved only for those at high risk.     

The antenatal diagnosis of congenital heart disease using fetal echocardiography: is color flow mapping necessary?

Doppler color flow mapping is widely used in fetal echocardiography. We studied the impact of color flow mapping on fetal cardiac diagnosess. Between January 1, 1989 and June 30, 1990, we performed 854 fetal echocardiograms on 776 fetuses. Color flow mapping was used in 45 of 48 fetuses diagnosed as having cardiac abnormalities. Scans were reviewed to assess how color flow mapping influenced the ultimate diagnoses. Color flow mapping was essential to the correct anatomical diagnoses in 13 fetuses (29%), helpful but not essential in 21 (47%), and added little to two-dimensional examination alone in 11 (24%). It was essential in determining the course and flow direction in the great vessels when outflow obstruction was present or with transposition, and it was helpful but not essential in locating small jets of atrioventricular valve regurgitation. It was not helpful when the anatomical abnormalities were clearly identified from two-dimensional examination alone. We conclude that color flow mapping is helpful in the delineation of anatomical diagnoses in three-quarters of cases of fetal heart disease, particularly when the great vessels are abnormal. It may speed examinations by directing pulsed Doppler sampling. We did not find it essential to the proper recognition of anatomically abnormal hearts.     

Doppler ultrasonographic evidence of intrapartum brain-sparing effect in fetuses with low oxygen saturation according to pulse oximetry.

OBJECTIVE: This study was undertaken to verify by means of Doppler ultrasonography and simultaneous fetal pulse oximetry the redistribution of fetal blood flow in favor of the brain during intrapartum hypoxemia. STUDY DESIGN: During labor 11 term fetuses with abnormal heart rate patterns and arterial oxygen saturation <30% and 14 control term fetuses with normal oxygen saturation were simultaneously monitored by pulse oximetry and Doppler ultrasonography. The results were compared with the Student t test. RESULTS: The blood flow velocity in the middle cerebral artery was significantly higher in the presence of reduced oxygen saturation, implying lower pulsatility and resistance indices (P <.001). The reduction of blood flow in the umbilical artery was not significant (P =.61). CONCLUSION: Simultaneous intrapartum pulse oximetry and Doppler ultrasonography proved that reduced arterial oxygen saturation (<30%) is associated with profound changes in fetal hemodynamics and could be tolerated for only a limited period, which should be the subject of further studies.     

The use of power Doppler and color power angiography in fetal imaging

OBJECTIVE: The potential usefulness of a new color Doppler ultrasonography technique called color power angiography in imaging fetal anatomy is presented. STUDY DESIGN: An ultrasonography system set on color power angiography was used to image fetal anatomy. Perfusion of normal organs was compared, with several fetuses demonstrating pathologic disorders of these organ systems. Color power angiography was compared with standard color Doppler imaging. RESULTS: We were able to demonstrate detailed imaging of the fetal vasculature in the lung, kidney, and brain. Abnormal lung and renal anatomy could be visualized by the distinctive perfusion ”footprint.” Fetal movement compromised the ability of color power angiography to visualize these structures but could be overcome by judicious use of the cineloop and persistence functions. Color power angiography was found to be more sensitive to low-flow states than was color Doppler imaging. CONCLUSION: Color power angiography, which is more sensitive to low-flow states than color Doppler imaging is, may be useful in the imaging of normal and abnormal fetal anatomic structures. (Am J Obstet Gynecol 1996;174:1828-33.)     

Early prenatal diagnosis of major cardiac anomalies in a high-risk population

OBJECTIVE: To examine the accuracy of early fetal echocardiography performed in a high-risk population combining transvaginal and transabdominal routes. METHODS: A series of 330 high-risk pregnancies were screened by transvaginal and transabdominal scan at 12-17 weeks' gestation in a prospective multicentre trial in Spain between September 1999 and May 2001. A total of 334 fetal heart examinations were performed, including four twin pregnancies. Maternal age ranged from 17 to 46 years (mean 33 years with 36% of women over 34 years). The median gestational age at scan was 14.2 weeks (range 12-17 weeks). For each fetus, visualization of the four-chamber view, the origin of the great arteries, aortic and ductal arches and systemic venous return was attempted in a segmental approach. B-mode and colour/pulsed Doppler flow imaging were used in all cases. The duration of complete heart examination was less than 30 minutes. The examinations were performed by three experienced operators. Reliability was assessed by conventional transabdominal echocardiography at 20-22 weeks, by postnatal follow-up in the first three months of life, and/or by autopsy in cases of termination of pregnancy. RESULTS: The rate of successful visualization of the fetal heart was 94.6% (316/334). In 48 out of 334 (14.4%) fetuses the final diagnosis was abnormal. In 38 out of 48 (79.2%) cases with heart defects the diagnosis was suspected at early echocardiography. In the group with congenital heart defects, 27 cases had an abnormal karyotype (56.3%) and 31 cases showed extracardiac anomalies (64.6%). There were 10 false-negative cases at early scan. There were no false-positive diagnoses. CONCLUSIONS: This experience stresses the usefulness of early fetal echocardiography when performed by expert operators on fetuses specifically at risk for cardiac disease. The high rate of successful visualization of the fetal heart provides a reliable diagnosis of major cardiac defects at this early stage of pregnancy.     

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。     

Fetal echocardiography. I: Methods, limitations and indications

The prenatal detection of congenital heart disease is rather seldom, compared with other fetal malformations. The paper considers the necessity of the development of fetal echocardiography and presents therefore an introduction for the prenatal sonographer. The fetal cardiac characteristics are first analysed, before considering the possibilities and frontiers of the investigation. The different available sonographic methods like the real-time, M-mode, pulsed Doppler and color Doppler are discussed and the importance of each one is emphasized. The indications for fetal echocardiography are further enumerated, as well as the possible consequences resulting from the diagnosis of a heart abnormality. Because of the sophisticated ultrasound devices needed for a precise diagnosis as well as the optimal postnatal care, suspected fetuses have to be referred to centers specialised in perinatal medicine.     

Should all pregnant diabetic women undergo a fetal echocardiography? A cost-effectiveness analysis comparing four screening strategies

OBJECTIVE: To determine if a policy of universal fetal echocardiography for all pregnant diabetic women is cost-effective as a screening tool for congenital heart defects. STUDY DESIGN: Using a decision-analysis model, we compared the cost-effectiveness of four screening strategies: (1) none--no ultrasound is performed; (2) selective fetal echocardiography after abnormal detailed anatomic survey; (3) fetal echocardiography for only high hemoglobin A1C, and (4) universal fetal echocardiography for all diabetics. The sensitivity and specificity for each strategy were derived by literature search. The analysis was from a societal perspective using a willingness-to-pay threshold (50,000 dollars) and a theoretic cohort of 40,000 pregnant diabetics. Costs included costs of tests and the costs of complications and of raising a child with a cardiac defect. Outcomes were reported as cost per quality-adjusted life years (QALY) gained for each congenital heart defect prevented by each strategy and the number of congenital heart defects detected. One-way, multiway and probabilistic sensitivity analyses were performed. RESULTS: Compared with the other strategies, selective fetal echocardiography after abnormal detailed anatomic survey costs less per QALY gained for cardiac defect screening. Although universal fetal echocardiography was associated with a higher detection rate for cardiac defects, it was more costly. The sensitivity analyses revealed a robust model over a wide range of values. CONCLUSION: Under the baseline assumptions, selective fetal echocardiography after an abnormal detailed anatomic survey is more cost-effective compared with universal fetal echocardiography as a screening strategy for cardiac defects in pregnant diabetics.     

Evaluation of fetal heart anatomy at the end of the first trimester and the beginning of the mid-trimester

OBJECTIVE: To evaluate fetal heart anatomy in the late first and in the early second trimester. MATERIALS AND METHODS: The study included 75 fetuses between 11 and 19 weeks' gestation. Exams were performed using transabdominal or transvaginal probes. RESULTS: The proportion of cases successfully visualized to all cases in particular week of pregnancy was following: 11 week--0/1 (0%), 12--1/1 (100%), 13 week--1/1 (100%), 14--18/23 (79%), 15--6/9 (67%), 16--23/27 (86%), 17--4/5 (80%), 18--6/6 (100%), 19--2/2 (100%). In 11 weeks' gestation two ventricles and two atrias could be imaged. Anatomy was seen from 12 weeks' gestation with transvaginal and from 13 weeks' gestation with transabdominal transducers. Two tricuspid regurgitations were detected. The interventricular septum was the most difficult structure to visualize in all cases. The grey scale alone was not sufficient for accurate examination of the heart and it was necessary to use colour Doppler to confirm normal forward flow to both ventricles and to identify outflow tracts. CONCLUSIONS: 1. Successful visualization of the heart in early pregnancy is possible from 12 weeks' gestation with transvaginal and from 13 weeks' gestation with transabdominal probe. 2. Fetal echocardiography between first and second trimester should lead to better understanding of fetal hemodynamics in normal and abnormal fetuses and help to introduce new therapeutic treatment in some cases.