多普勒超声心动图诊断胎儿心脏肿瘤的临床意义

目的:研究多普勒超声心动图宫内诊断胎儿心脏肿瘤及合并胎儿充血性心衰(CHF)的临床意义。方法:胎儿超声心动图顺序分段法检查胎儿心脏肿瘤并评价其血流动力学改变。结果:检出心脏肿瘤12例,其中7例出现心脏肥厚扩大,2例出现胎儿水肿,表现为心胸面积比增大,心房、心室的不对称增大或心肌肥厚及心室缩短率(FS%)及心输出量(CCO)改变(P<0.001);8例中至重度二、三尖瓣反流(MR、TR),3例肺动脉瓣反流;2例出现脐静脉搏动性血流,腔静脉内径增宽及血流频谱改变。结论:应用多普勒超声心动图可清晰显示胎儿心脏肿瘤,评价与CHF的相关因素。通过主动脉和肺动脉CO的总和CCO可无创获得心输出量的指标及计算FS研究量化胎儿心功能,并可评价心内及外周血流动力学变化。     

多普勒超声心动图对胎儿充血性心衰的研究

目的应用多普勒超声心动图研究、探讨胎儿充血性心力衰竭(CHF)的病变机制,为早期宫内诊断和治疗及疗效评价提供准确依据。方法超声心动图检出并诊断41例CHF胎儿及正常对照组50例。结果(1)41例胎儿中先天性心脏病14例;重症心律失常15例,胎儿肿瘤5例,双胎输血综合征5例和胎儿贫血2例;(2)均出现胎儿水肿;心脏显著肥厚扩大,表现为心胸比例增大,心房、心室的不对称增大或心肌肥厚。心室缩短率(FS%)及心输出量(CCO)降低(P<0.001);(3)中至重度二、三尖瓣返流(MRTR),9例肺动脉瓣返流;(4)32例胎儿脐动脉PI值增高或舒张期血流相消失及大脑中动脉PI值降低。37例出现脐静脉搏动性血流及41例均示下腔静脉内径增宽及血流频谱改变。结论应用多普勒超声心动图评价胎儿CHF的导致因素,通过主动脉和肺动脉CO的总和CCO可无创获得心输出量的指标及计算FS以达到量化胎儿心功能的目的。可直观地显示胎儿心脏结构,检测瓣膜返流及评价外周血流动力学变化。     

胎儿Ⅲ＆#176;房室传导阻滞产前超声心动图分析

目的：总结Ⅲ°房室传导阻滞（CAVB）胎儿超声心动图特征。方法应用二维超声、M型超声及多普勒技术对10例Ⅲ°房室传导阻滞胎儿进行超声心动图检查,观察胎儿心房与心室节律及其对应关系,同时观察二尖瓣、左心室流入道及流出道、静脉导管血流频谱,并对胎儿心脏大小、心功能、房室瓣反流及心包积液等心脏结构进行观察,对Ⅲ°房室传导阻滞胎儿超声心动图特征进行总结分析。结果二维超声心动图检查提示10例Ⅲ°房室传导阻滞胎儿中2例存在心内外畸形,8例无明显心内外畸形。Ⅲ°房室传导阻滞胎儿M型超声心动图特征为房室节律分离,心房节律保持在正常范围而心室节律缓慢,多普勒超声心动图特征为二尖瓣频谱提示E峰频率缓慢,A峰频率明显快于E峰频率,E、A峰无固定对应关系。胎儿超声心动图检查提示,孕妇就诊时10例胎儿中6例心脏扩大,5例心功能不全,6例房室瓣反流,7例心包积液。超声心动图检查后10例孕妇均选择引产。结论Ⅲ°房室传导阻滞是对胎儿心功能有重要影响的缓慢型心律失常,预后不佳。M型超声结合多普勒技术可对Ⅲ°房室传导阻滞胎儿进行诊断及鉴别,对临床干预治疗及判断胎儿预后有重要意义。     

多普勒超声心动图对胎儿心功能的研究

我们利用多普勒超声心动图记录76例孕龄从21周到42周的正常胎儿心脏各瓣膜血流频谱,测量 1.最大血流速度;2.血流频谱积分;3.主动脉、肺动脉血流的加速时间、射血时间;4.二尖瓣、三尖瓣血流的E峰、A峰;计算通过各瓣口的每搏量、心排量。结果显示了多普勒超声心动图研究胎儿心功能的可行性,并进一步证实胎儿循环右心占优势,胎儿循环处于高阻力状态及胎儿心室肌舒张功能减低。     

胎儿非结构性心脏病心腔增大的相关因素及超声检查线索

目的：探讨胎儿心腔增大的非心脏结构病变因素及病变机制，为超声评价胎儿心腔增大提供筛查线索及合理的医疗干预依据。方法：对30例非心脏结构病变心腔增大胎儿（简称心脏增大组）的病因，进行超声随访、病理证实，并对比治疗前后胎儿血流动力学变化，分析胎儿心腔增大病理机制，明确超声检查线索。结果：心脏增大组原因分心外因素（20例）、心脏因素（7例）、不明原因（3例）。其血流参数：右室短轴缩短率（RVFS）、右室射血指数（RVEF）、大脑中动脉血流阻力指数（MCARI）、脐动脉血流阻力指数（UARI）与正常对照组比较有显著差异（P<0.01）。经母体常压氧疗法及口服强心药（简称期待疗法）治疗后，心脏增大组血流参数显著好转（P<0.01），分娩后86.7%（26/30）心功能正常。结论：胎儿非心脏结构病变心腔增大有一定规律可循，超声检查可明确病因，多属一过性心功能不良。     

颈项透明层增厚及三尖瓣反流在胎儿早期心脏畸形筛查中的价值

目的：探讨胎儿颈项透明层（Nuchaltranslucensy,NT）增厚及三尖瓣反流在早期先天性心脏畸形（Congenital heart disease,CHD）筛查中的临床意义。方法：选取323例先天性心脏病高危孕妇,所有胎儿孕11～14周检测NT,应用脉冲多普勒超声获取三尖瓣血流频谱,进行相应的血流频谱分析;同时对NT增厚及三尖瓣反流的胎儿行超声心动图检查,对可疑CHD的胎儿于孕18～20周再次行超声心动图检查以确诊或除外CHD;对NT及三尖瓣频谱正常的胎儿于孕20～24周行超声心动图检查。所有活产儿于出生后1周内行超声心动图检查,引产的胎儿争取尸体解剖。结果：共检查早孕期胎儿323例,检出NT增厚胎儿123例,产前产后证实21例患有CHD;三尖瓣反流胎儿40例,产前产后证实16例患有CHD,其中3例为复杂型CHD。结论：胎儿NT增厚及三尖瓣反流可作为胎儿CHD早期筛查指标。     

胎儿动脉导管狭窄超声心动图诊断分析

目的探讨超声心动图诊断胎儿动脉导管狭窄的价值。方法孕32~38周孕妇常规产科超声检查发现胎儿右心增大伴三尖瓣反流58例,进一步行胎儿超声心动图检查,于动脉导管横断面、三血管气管切面和动脉导管弓切面观察导管形态,测量导管内径及血流频谱。结果超声诊断胎儿动脉导管狭窄6例,均表现右心明显增大,三尖瓣中-重度反流,三尖瓣最大反流速度3.5~4.5m/s,最大压差(maximum transprosthetic pressure gradient,MTPG)49~81mm Hg;胎儿动脉导管呈弯曲或折角现象,管腔细窄,内径1.5~2.5 mm,收缩期峰值血流速度1.8~3.2 m/s,MTPG 13~41mm Hg,舒张期血流速度0.4~2.0m/s,MTPG 0.64~16.00mm Hg;胎儿出生后7d~3个月复查心脏超声,2例三尖瓣反流消失,4例仅有少量反流,心脏大小、形态均恢复正常。结论胎儿超声心动图可显示动脉导管形态和血流异常,较早发现胎儿动脉导管狭窄,评估胎儿风险,对提高围产儿安全有重要价值。     

胎儿心肌病产前超声表现及病因分析1例

孕妇29岁, 孕24+4周, 孕3产2, 第一胎生育一女孩, 第二胎因胎儿心脏异常引产一男性胎儿, 具体病因不祥。本次为自然妊娠, 妊娠13周、19周超声检查未见异常, 23周系统超声检查发现胎儿心脏增大、皮下水肿, 其他结构未见异常。孕妇既往体健, 孕期实验室检查未见异常, 夫妻非近亲结婚, 配偶体健, 孕妇父母及一弟一女体健。因产前超声检查异常转诊来我院, 行胎儿超声心动图检查:四腔心切面显示心胸面积比值增大(45%), 心包腔积液, 左心室增大, 左心室壁及心尖部增厚, 左心室腔内膜面回声增强, 可见多个大小不等肌性突起(图1A)。彩色多普勒血流显像示:左心室腔肌性突起间可见血流信号由心腔进入(图1B), 二尖瓣中量反流, 反流速度210 cm/s(图2A), 三尖瓣大量反流, 反流速度180 cm/s(图2B), 脐动脉舒张末期血流消失(图2C), 脐静脉见搏动征(图2D), 静脉导管A波反向(图2E)。胎儿全身扫查见胸腹腔积液, 皮下组织水肿(图2F), 胎儿心率及节律未见异常, 参考胎儿超声心动图心功能评分体系半定量评价胎儿心功能:胎儿心血管评分总分为3分。胎儿超声心动图提...     

超声心动图诊断心肌致密化不全的价值

目的探讨超声心动图对心肌致密化不全（NVM）的诊断价值。方法分析2002年1月-2012年10月31例NVM患者的超声心动图表现,重点于左室长轴、心室短轴、心尖四腔及心尖两腔等切面观察室壁的结构及运动,判断心功能、瓣膜反流的情况。结果31例NVM患者二维超声心动图示病变部位心肌心内膜面弥漫分布丰富肌小梁交织呈网状及其深陷其间的隐窝,彩色多普勒超声示隐窝内低速血流,并与心腔内高速血流相通。28例呈左室型（90．3％）,以近心尖1／3～2／3的心肌尤为显著;2例呈右室型（6．5％）;1例呈双室型（3．2％）;1例隐窝内形成血栓（3．2％）。结论超声心动图能清晰显示心内结构,客观评价心功能,对NVM具有重要的诊断价值。     

胎儿心室发育不良的产前超声心动图诊断价值

目的　探讨产前超声心动图对胎儿心室发育不良的诊断价值。方法　回顾性分析我院 2 6 4 8例行中孕超声筛查和高度怀疑胎儿心脏畸形的晚孕孕妇。首先确定胎儿心脏的位置及心轴 ,然后心脏三节段分析法进行分析。二维超声显示四腔心、左室流出道、右室流出道、心底短轴、主动脉弓、动脉导管弓及三血管切面 ,重点观察二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣的启闭情况 ,再用多普勒超声和 M-型超声观察胎儿心脏各瓣膜的血流情况。结果　 2 6 4 8例行常规超声筛查孕妇中检出先天性心脏畸形 2 1例 ,其中心室发育不良 6例 (3例左心发育不良综合征和 3例右心发育不良 )。 6例心室发育不良均已引产并有 3例尸检 ,尸检结论与超声完全一致。结论　产前超声心动图对检出胎儿心室发育不良及其分型具有极重要的价值。二维超声心动图是根本 ,而多普勒超声和 M-型超声心动图也不可或缺。     

Likelihood ratio for trisomy 21 in fetuses with tricuspid regurgitation at the 11 to 13 + 6-week scan.

OBJECTIVE: To determine the likelihood ratio for trisomy 21 in fetuses with tricuspid regurgitation at the 11 to 13 + 6-week scan. METHODS: Fetal echocardiography was carried out by specialist pediatric cardiologists in 742 singleton pregnancies at 11 to 13 + 6 weeks' gestation and pulsed wave Doppler was used to ascertain the presence or absence of tricuspid regurgitation. To avoid confusion with other adjacent signals, a strict definition of tricuspid regurgitation was used, in that it had to occupy at least half of systole and reach a velocity of over 80 cm/s. The fetal crown-rump length (CRL) and the nuchal translucency (NT) thickness were measured and the presence of any congenital heart abnormality noted. Follow-up of the pregnancy was carried out to determine the presence of chromosomal abnormalities. The likelihood ratio for trisomy 21 in fetuses with and without tricuspid regurgitation was determined. RESULTS: The tricuspid valve was successfully examined in 718 (96.8%) cases. Tricuspid regurgitation was present in 39 (8.5%) of the 458 chromosomally normal fetuses, in 82 (65.1%) of the 126 with trisomy 21, in 44 (53.0%) of the 83 with trisomy 18 or 13, and in 11 (21.6%) of the 51 with other chromosomal defects. The prevalence of tricuspid regurgitation was also associated with fetal CRL, delta NT and the presence of cardiac defects. Logistic regression analysis, irrespective of cardiac defects, demonstrated that in the chromosomally normal fetuses significant independent prediction of the likelihood of tricuspid regurgitation was provided by fetal delta NT (odds ratio (OR), 1.26; 95% CI, 1.34-1.41; P < 0.0001), while in trisomy 21 fetuses prediction was provided by CRL (OR, 0.94; 95% CI, 0.89-0.99; P = 0.021). The likelihood ratio for trisomy 21 for tricuspid regurgitation was derived by dividing the likelihood in trisomy 21 by that in normal fetuses. In the chromosomally normal fetuses, the prevalence of tricuspid regurgitation in those with cardiac defects was 46.9% and 5.6% in those without cardiac defects, and the likelihood ratio of tricuspid regurgitation for cardiac defects was 8.4. CONCLUSION: At 11 to 13 + 6 weeks' gestation, there is a high association between tricuspid regurgitation and trisomy 21, as well as other chromosomal defects. The prevalence of tricuspid regurgitation increases with fetal NT thickness and is substantially higher in those with, than those without, a cardiac defect.     

Structural and functional cardiac abnormalities identified prior to 16 weeks' gestation in fetuses with increased nuchal translucency.

OBJECTIVE: To determine the accuracy and practicality of fetal echocardiography in the identification of structural and functional cardiac abnormalities prior to 16 weeks' gestation in fetuses with increased nuchal translucency thickness (NT). METHODS: Between January 1996 and June 2002 early fetal echocardiography using the transvaginal route was performed at 12-16 weeks' gestation on 275 fetuses with increased NT. The abnormal cardiac findings were classified as either structural (congenital heart defects) or functional, defined as transient phenomena which might later disappear, such as isolated tricuspid regurgitation and an enlarged ascending aorta. The abnormal findings were related to pregnancy outcome, including autopsy results, karyotyping results, and late fetal and neonatal echocardiography. RESULTS: Cardiac abnormalities were present in 61 fetuses overall (22.2%); including structural cardiac defects in 37 fetuses (13.5%) and functional abnormalities in 24 fetuses (8.7%). Structural cardiac abnormalities were associated with abnormal karyotype in 24 fetuses and normal karyotype in 13 fetuses. Of the 24 fetuses with functional cardiac abnormalities, 2 (8.3%) had isolated tricuspid regurgitation and 22 (91.7%) had enlarged ascending aorta. Abnormal karyotype was present in this group in 4 cases (16.7%). CONCLUSION: Increased NT can be used to define a high-risk group that should receive specialized early fetal echocardiography. This is a reliable technique with great potential for the diagnosis of both structural and functional cardiac abnormalities.     

Prenatal echocardiographic differential diagnosis of fetal cardiac tumors.

OBJECTIVES: To present data on echocardiographic findings of fetal cardiac tumors and discuss their differential diagnoses. METHODS: We retrospectively reviewed 14 cases of fetal echogenic cardiac mass diagnosed between 1990 and 2003; 12 were confirmed to be cardiac tumors and two were false-positive diagnoses. The echocardiographic characteristics examined included number, size, location and associated complications. RESULTS: Eight fetuses had a single tumor and four fetuses had multiple tumors. The left ventricle was most often affected. Parents of eight fetuses opted for termination of pregnancy, one fetus died in utero and three affected fetuses survived. Histopathological examination revealed cardiac rhabdomyoma in six fetuses, fibroma in two, teratoma in two, lipoma in one and hemangioma in one. The pitfalls associated with prenatal echocardiographic diagnosis of cardiac tumors include: they may be too small to be visualized, intracardiac echogenic foci may mimic tumors, and echogenicity resulting from extracardiac structures or neoplasms near the heart may falsely appear as tumors. CONCLUSION: Fetal cardiac tumors can be detected by echocardiography. However, differential diagnosis is important as this will affect prognosis and subsequent management.     

Impact of altered loading conditions on ventricular performance in fetuses with congenital cystic adenomatoid malformation and twin-twin transfusion syndrome.

OBJECTIVES: In the fetus with a structurally normal heart, two conditions--giant chest mass, such as congenital cystic adenomatoid malformation (CCAM), and twin-twin transfusion syndrome (TTTS)--alter ventricular loading conditions and may result in cardiovascular compromise. The aim of this study was to elucidate the mechanism of cardiovascular dysfunction by comparing geometry-independent, Doppler flow-derived measures of ventricular performance in fetuses with altered loading conditions vs. those in normal fetuses. METHODS: Doppler flow-derived measures of myocardial performance index (MPI) as described by Tei, ventricular ejection force as described by Isaaz, and combined cardiac output (CCO) were obtained by echocardiography in fetuses with a normal cardiovascular system (n = 76) or CCAM (n = 36) and fetal partners with TTTS (n = 22). RESULTS: In the CCAM group, systolic performance as evidenced by the ejection forces was preserved, right ventricular (RV) MPI was increased and CCO diminished, suggesting diastolic dysfunction and poor filling secondary to cardiac compression and a tamponade effect. In TTTS, recipient twins exhibited greater left ventricular (LV) ejection forces and higher CCO than donor twins, and had abnormal RV and LV MPI, reflecting increased preload, preserved left systolic performance, but diastolic dysfunction. Donor twins had diminished ejection forces and CCO in comparison with normal controls and recipient partners, reflecting hypovolemia. CONCLUSIONS: In both CCAM and recipient twins of the TTTS, diastolic dysfunction plays a significant role in the pathophysiology of each disorder and precedes changes in systolic performance. Measures of ventricular performance can help elucidate poorly understood mechanisms of cardiovascular compromise in the developing fetus.     

胎儿心脏肿瘤与结节性硬化症的关系

目的 探讨胎儿心脏肿瘤与结节性硬化症的关系。方法 回顾性分析产前超声发现胎儿心脏肿瘤的13胎超声及MRI资料。结果 13胎心脏肿瘤中,5胎为单发肿瘤,8胎为多发肿瘤;MRI发现颅内结节性硬化6胎,其中2胎心脏肿瘤为单发、4胎心脏肿瘤为多发。结论 胎儿心脏肿瘤多与结节性硬化症有关。产前超声发现胎儿心脏肿瘤时,应行产前颅脑MR检查,以早期诊断结节性硬化症。     

Implications of bidirectional flow in the great arteries at the 11-14-week scan.

OBJECTIVE: To determine the implications of a bidirectional Doppler flow pattern detected in one or both of the fetal great arteries in the first trimester. METHODS: Database records were reviewed for cases of bidirectional flow found on fetal echocardiography performed at less than 15 weeks of gestation between January 1999 and October 2006 inclusive. Bidirectional flow consisted of antegrade flow in systole and retrograde flow in diastole. Data including indication for fetal echocardiography, gestational age at diagnosis, the anatomical features, karyotype, nuchal translucency measurement and outcome were collected. RESULTS: From almost 2500 scans, bidirectional flow was detected in a total of 15 fetuses. The abnormal flow pattern was confined to the aorta in four, to the pulmonary artery in four, and was present in both great arteries in a further seven fetuses. Eight of the 15 fetuses had regurgitation at one or both atrioventricular valves. Additional cardiac abnormalities were detected by ultrasound in eight cases. Of the 13 cases for which the karyotype was known, 12 were abnormal and five of these had trisomy 18. None of the fetuses survived. There were two intrauterine deaths and 13 terminations of pregnancy. CONCLUSION: Bidirectional flow in one or both great arteries is an unusual finding at the first-trimester scan and must be distinguished from the retrograde flow occurring only in systole in duct-dependent heart defects. It carries a poor prognosis, which is a consequence of both the high chance of underlying chromosomal abnormality and the hemodynamic compromise associated with severe arterial valve regurgitation.     

三维超声检测先天性心脏病胎儿的产尿率

目的尝试建立国人胎儿产尿率(UPR)的正常值,并以此评估先天性心脏病(CHD)胎儿的UPR改变情况。方法选择连续检测的49胎CHD胎儿作为病例组,将其分为左心梗阻性病变组、右心梗阻性病变组和混合心脏畸形组;根据胎儿CHD有无合并充血性心力衰竭(CHF)再分为合并CHF组和未合并CHF组。选取同期正常21～40孕(GA)周单胎妊娠胎儿314胎作为正常对照组。采用三维超声体积自动测量(VOCAL)技术测量各组胎儿UPR并进行比较。结果①胎儿UPR随GA增大而增加(r2=0.92,P<0.05),相关方程为:ln(UPR)=-4.7480+(0.3975×GA)+(-0.0044×GA2);②胎儿UPR的改变与胎儿有无CHD及其CHD类型无关(P>0.05);③胎儿UPR与胎儿CHD的心脏功能有关,CHD胎儿合并CHF时UPR下降(P<0.01)。结论 UPR可能是判断胎儿心力衰竭的一项有价值的指标。     

Atrioventricular block detected in fetal life: associated anomalies and potential prognostic markers.

OBJECTIVES: To assess the spectrum of anomalies associated with fetal heart block and to identify possible prognostic markers. METHODS: Retrospective review of all cases of second- or third-degree heart block identified in two tertiary referral centers in Germany (Bonn and Lübeck) and one in the USA (Baltimore). RESULTS: Sixty fetuses with heart block were identified in the study period. Thirty-two had complex cardiac malformations, 31 of them associated with left isomerism. The outcomes of these fetuses were 22 terminations of pregnancy (TOP), three intrauterine fetal deaths (IUFD), three neonatal deaths (NND), two childhood deaths (CD) and there were two survivors. In 20 cases without complex cardiac malformations maternal antinuclear-antibodies were detected. Their outcomes were 2 TOP, 1 IUFD, 1 NND and 16 survived. The remaining eight cases had neither complex cardiac malformations nor associated maternal antibodies. Their outcomes were 1 TOP, 2 IUFD, 2 NND and 3 survived. After exclusion of terminated cases, hydrops as well as the presence of cardiac defects was significantly associated with non-survival (P < 0.01). The cardiothoracic circumference ratio was significantly higher in hydropic fetuses and significantly negatively correlated with survival in immune-mediated cases (P < 0.01). Atrial and ventricular frequencies and their evolution did not accurately predict fetal or neonatal outcome. Sympathomimetic treatment in seven cases was not associated with favorable fetal outcome in cases of hydrops or cardiac malformations. CONCLUSIONS: The most important marker predicting adverse outcome in cases of heart block is fetal hydrops, followed by the association with complex cardiac malformations. Cases without cardiac malformations have a significantly better prognosis, especially in the absence of severe cardiomegaly.     

Ventricular volume overload in the human fetus: observations from fetal echocardiography

We examined two groups of fetuses in which echocardiography had been performed and in which ventricular volume overload eventually led to fetal hydrops. The first group (18 fetuses) had atrioventricular valve regurgitation and almost all of the fetuses had structural heart disease. No fetus in this group survived the neonatal period; only two of the pregnancies in this first group were terminated. A second group of three fetuses had ventricular volume overload from sacrococcygeal teratomas at 21 to 24 weeks' gestation. These fetuses also had nonimmune hydrops (or it developed), but they did not have structural heart disease or atrioventricular valve regurgitation. Combined ventricular output in this group was calculated by Doppler ultrasound to be greater than twice the normal output for fetuses of the expected gestational weight. The proportion of the combined output to the lower body and the placenta was increased with the increase to the teratoma, exceeding the increase to the placenta. In one fetus, serial study demonstrated increasing output and the development of hydrops. Intrauterine surgery was undertaken to control the high output failure. The abnormal variables tended to revert to normal after replacement of blood loss, and the hydrops disappeared. The pregnancy continued until the spontaneous rupture of membranes at 26 weeks' gestation forced delivery by cesarean section. The infant died from severe hyaline membrane disease. These findings suggest that, in some circumstances, fetal hydrops is a late sign of cardiac failure and heralds incipient death.(ABSTRACT TRUNCATED AT 250 WORDS)