不同孕周正常胎儿心脏大小的超声评价

目的:探讨不同孕周正常胎儿心脏大小的超声特征,分析其与孕周的相关性.方法:将2017年4月—2019年10月我院孕20～36+6周正常孕妇及其胎儿280例按不同孕周段分为A、B、C、D组,测量左心房(LA)、左心室(LV)、右心房(RA)、右心室(RV)、主动脉(AO)、肺动脉(PA)、卵圆孔(FO)、动脉导管(DA)...     

胎儿心脏横径与孕周的相关性研究

目的:应用产前超声测量正常胎儿心脏横径,探讨胎儿心脏横径与孕周的关系及建立不同孕周胎儿心脏横径参考值范围.方法:选自2018年1月—2020年6月期间在北京大学深圳医院超声影像科进行常规产前超声检查的符合纳入条件的2398例正常胎儿进行前瞻性横断面研究,测量胎儿心脏横径,按不同孕周分组,进行直线回归分析.结果:胎儿心脏...     

不同孕周正常胎儿心脏大小的超声检测与临床意义

目的 探讨产前超声检查胎儿心脏生长指标与孕周的相关性.方法 应用二维超声测量14～39周正常胎儿左心房(LA)、右心房(RA)、左心室(LV)、右心室(RV)、主动脉(AO)和肺动脉(PA)内径及卵圆孔大小(FO)、心脏面积(HA)、胸腔面积(TA)、心脏周长(HC)、胸廓周长(TC),分析孕周与测量值的关系. 结果 线性回归分析表明,胎儿时期心脏各腔室大小、AO、PA及室间隔(IVS)厚度随孕龄增加而增大,与孕周呈显著正相关;肺动脉与主动脉内径比值(PA/AO)、左心房与右心房内径比值(LA/RA)、左心室与右心室内径比值(LV/RV)、心脏周长与相应胸廓周长比值(HC/TC)、心脏面积与相应胸廓面积比值(HA/TA)与不同孕周比较各比值变化不明显. 结论胎儿心脏随孕龄增加而增大,其中心脏面积与孕周最具相关性.     

正常胎儿不同孕周房室腔及大血管参数的超声心动图检测

目的测定不同孕周胎儿房室腔正常值范围、大血管径线及血流速度,评价各孕周房室腔大小及血流速度与孕周的动态变化规律。方法 4139例中晚期孕妇根据不同孕周分为三组,A组:孕18~22周(91例);B组:孕23~28周(3315例);C组:孕29~40周(733例)。超声心动图扫查胎儿心脏,测量各相关参数,分析各参数与孕周的关系。结果各组间胎儿心脏房室腔、大血管径线正常值及胎儿心脏血流速度正常值比较,差异均有统计学意义(P0.05)。主动脉、主肺动脉、右肺动脉、左肺动脉、动脉导管内径、动脉导管长度、左房长径、左房横径、右房长径、左房横径、左室长径、左室横径、右室长径、右室横径、卵圆孔内径、室间隔厚度、左室壁厚度、右室壁厚度、动脉导管收缩期流速与孕周均呈正相关(P0.05)。结论正常胎儿心脏发育各心腔及大血管的径线与孕周呈正相关,这可为胎儿心脏发育异常及胎儿先天性心脏病的超声诊断提供正常对照。     

孕中晚期心脏结构正常胎儿的右心功能观察

目的 观察孕中、晚期心脏结构正常胎儿的右心收缩及舒张功能的变化规律,并探讨其临床意义.方法 选取就诊我院门诊的196例心脏结构正常的中、晚孕单胎妊娠胎儿,孕龄20～37周,根据孕龄分为两组:孕龄＜28周(中期)124例;孕龄≥28周(晚期)72例.以M型超声心动图测量胎儿三尖瓣环收缩期纵向位移(TAPSE);脉冲多普勒...     

正常胎儿心脏发育与孕周增长关系的初步探讨

目的 初步探讨二维超声心动图在研究胎儿心脏发育与孕周增长关系中的应用价值.方法 回顾分析386例正常胎儿超声心动图测值,统计胎儿心脏横径、左右房室横径、主动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速,以及心率随孕周变化增长的关系,分析正常胎儿心脏发育趋势;比较胎儿左右房室大小.结果 ①胎儿心脏横径、左右房室横径、主动脉内径、主动脉及肺动脉流速、动脉导管舒张期和收缩期流速与孕周之间均呈线性相关关系,随孕周增长而增长,心脏横径与孕周间的线性相关性最大,动脉导管舒张期流速受孕周影响最小;胎心率与孕周无明显线性相关;②右心系统横径大于左心系统横径,右心房横径与左心房横径,右心室横径与左心室横径间比较差异有统计学意义;③心脏横径/孕周比值及心脏横径/胸廓横径比值均呈正态分布,前者均数为0.95,接近1.0;后者均数0.44,小于0.5.结论 二维超声心动图可作为评估胎儿心脏发育的检测方法.     

超声心动图对胎儿心脏强回声结构的检测及其心功能评价

目的 探讨超声心动图检测胎儿心脏强回声结构(intracardiac hyperechogenic focus,ICEF)及对ICEF胎儿心功能评价的临床意义.方法 采用胎儿超声心动图对1291例孕22～40周胎儿进行检测,对检出的ICEF胎儿测量心脏大小及室壁厚度,定量主动脉瓣口、肺动脉瓣口、房室瓣口血流速度,测量房室瓣环舒张早期、舒张晚期及收缩期运动的峰值速度(Em、Am、Sm);随机选择128例正常胎儿作为对照组并测量相关参数;比较单纯ICEF胎儿与正常胎儿间的心脏收缩及舒张功能参数.结果 共检出ICEF胎儿448例,检出率34.7%(448/1291),其中伴先天性心血管畸形24例(5.4%),轻度三尖瓣反流24例(5.4%),染色体异常1例(0.22%).399例单纯ICEF胎儿与正常胎儿之间比较,二维及M型超声心动图所测心脏大小及室壁厚度等参数差异均无统计学意义(P＞0.05),单纯性ICEF胎儿与正常胎儿之间比较,主动脉瓣口、肺动脉瓣口、房室瓣口血流流速曲线及房室瓣环运动速度参数差异均无统计学意义(P＞0.05).结论 单纯性的ICEF胎儿伴发染色体异常的几率较低,并不伴明显血流动力学改变.     

胎儿心脏定量分析技术对生长受限胎儿心脏结构及功能的评估价值

目的 探究胎儿心脏定量分析技术(Fetal HQ)评估生长受限胎儿(FGR)心脏结构及功能的价值。方法 以350例单胎孕妇为研究对象,其中FGR 42例(FGR组,早发型20例,晚发型22例),非FGR 308例(NFGR组),均接受常规超声及Fetal HQ检查。对比各组常规超声与Fetal HQ参数。结果 FGR组孕妇超声胎儿脐动脉(UA)-搏动指数(PI)、UA-阻力指数(RI)、Tei指数均显著大于NFGR组(P<0.05),大脑中动脉(MCA)-PI、MCA-RI均显著小于NFGR组(P<0.05)。FGR组四腔舒张末期长径、舒张末期室间隔厚度(IVSd)、左心室后壁厚度(LVPWd)、左心室/右心室面积变化分数(LV/RVFAC)、左心室/右心室纵向应变(LV/RVGLS)、心输出量(CO)及每搏输出量(SV)均显著低于NFGR组(P<0.05)。早发型组与晚发型组Fetal HQ各参数对比差异均无统计学意义(P>0.05)。结论 Fetal HQ能有效评估FGR胎儿心脏形态、结构及功能,或许有利于FGR胎儿心功能监测及治疗干预。     

孕20～40周正常胎儿心脏各径线超声心动图测值

目的测量孕20～40周正常胎儿心脏左心房、右心房、左心室、右心室、主动脉、肺动脉各径线参数,评价其动态变化规律。方法以二维超声对854例正常胎儿心脏各径线进行测量,得出各项参数,按孕周分为五组:20～24周;25～28周;29～32周;33～36周;37～40周。计算每组中各项参数的平均值;每组之间及各参数与孕周均进行相关分析比较。结果胎儿心脏各径线参数均与孕周直线关系较密切(左心室、右心室、左心房、右心房、主动脉内径、肺动脉内径的相关系数r值分别为0.69、0.68、0.70、0.68、0.73、0.72),同时进行相关系数的显著性检验,得出均P<0.05,具有统计学意义。结论胎儿心脏各径线大小与孕周呈明显相关,据此可评价胎儿心脏发育情况,胎儿心脏发育以右心占优势;掌握此孕周范围胎儿心脏各径线正常值,对于更准确的识别胎儿先心病具有很大帮助。     

孕11～14周正常胎儿心脏经阴道与腹部超声检查的对比研究

目的探讨经阴道超声检查观察孕11～14周胎儿心脏的方法及其诊断价值。方法对158例有高危妊娠病史及胎儿颈项透明层增厚且胎儿心脏正常的孕妇,于孕11～14周采用经阴道超声检查及腹部超声检查进行胎儿心脏检查。结果经阴道超声检查对孕12+0～12+6周、孕13+0～13+6周、孕14+0～14+3周胎儿心脏四腔心、左心室流出道及右心室流出道切面的显示明显优于腹部超声检查,两者相比差异有统计学意义(P0.01,P0.05)。而经阴道超声检查对孕11+0～11+6周胎儿心脏各切面的显示与腹部超声检查相比差异无统计学意义(P0.05)。结论对早孕晚期及中孕早期的高危孕妇行经阴道超声检查有临床应用价值。     

Utility of Fetal Echocardiography After Normal Cardiac Imaging Findings on Detailed Fetal Anatomic Ultrasonography

Objective. The purpose of this study was to assess the utility of fetal echocardiography (FE) after normal fetal cardiac imaging findings during detailed fetal anatomic ultrasonography (FAU). Methods. We conducted a retrospective cohort review of obstetric ultrasonographic studies from November 2001 through July 2005. We identified women with a singleton gestation with increased risk for congenital heart disease who received FAU performed by a maternal‐fetal medicine specialist at 16 to 20 weeks' gestation with subsequent FE. These records were compared with newborn outcomes. Results. Of 789 pregnancies that had FAU and FE, 481 had satisfactory cardiac imaging. Of those, only 1 fetus had abnormal FE findings. After delivery, 4 of the 480 neonates with normal FAU and FE findings had a diagnosis of a heart defect. Conclusions. Fetal echocardiography does not substantially increase the detection rate of major cardiac anomalies after normal findings on detailed FAU performed by a maternal‐fetal medicine specialist.     

Quality of 2‐ and 3‐Dimensional Fast Acquisition Fetal Cardiac Imaging at 18 to 22 Weeks

Objective. The purpose of this study was to evaluate the frequency with which 6 different fetal cardiac views taken during a fetal ultrasound examination at 18 to 22 weeks' gestation can be obtained satisfactorily for cardiac anomaly screening using either a 2‐dimensional (2D) static or 3‐dimensional (3D) fast acquisition technique. Methods. A prospective study of 100 low‐risk women undergoing an anatomic survey was performed. Standard static 2D and 3D fast acquisition volumes were obtained on all patients. The 2D and 3D images were assigned, in a random order, to be independently graded by 3 reviewers. The degree of inter‐reviewer agreement was assessed through the use of the Cohen κ statistic. The factors contributing to satisfactory imaging were evaluated by random effects logistic regression. Results. A significant proportion of both 2D and 3D images were judged unsatisfactory for screening purposes. However, 2D images were significantly more likely, for all cardiac views, to be judged satisfactory (P < .05). The odds ratios for the 2D technique's being more likely than the 3D technique to provide images satisfactory for screening were 2.6 for the 4‐chamber view, 2.4 for the right ventricular outflow tract, 4 for the left ventricular outflow tract, 3.2 for the 3‐vessel view, 8.6 for the aortic arch, and 2.2 for the ductal arch. Conclusions. In this prospective study, static 2D imaging was significantly more likely than fast acquisition 2D imaging to yield cardiac views of high enough quality to satisfactorily screen for anomalies.     

产前超声检测胎儿心脏功能的研究进展

超声仪器对胎儿心脏功能的检测有重要作用.产前超声在诊断胎儿心脏病方面发挥了不可替代的作用,随着计算机和超声仪器的发展进步,超声心功能测定方法也得到进一步完善,一些测量指标的变化规律可以反映胎儿心脏的收缩、舒张及全心功能.文章针对胎儿心动图评价胎儿心功能的各种检测方法及测量指标作一综述.     

Cardiac Pacing in Fetal Lambs: Intrauterine Transvenous Cardiac Pacing for Fetal Complete Heart Block

To evaluate the feasibility of intrauterine transvenous cardiac pacing, the right ventricular output was measured during pacing in six fetal lambs. Under maternal anesthesia, the uterus was opened, and, under local anesthesia, the pacing lead (Medtronic Capsure SP4023) was inserted via the fetal left internal jugular vein. Right ventricular output was estimated using an Aloka SSD-730 ultrasound device, and tricuspid valve regurgitation was evaluated with an Aloka SSD-880 using the transuterine approach. The ultrasonic right ventricular cardiac output was measured under three different conditions: (1) with the tip of the pacing lead in the superior vena cava (control); (2) with the tip of the pacing lead in the right ventricle; and (3) with pacing at 200 beats/min. The right ventricular output decreased when the pacing lead was inserted into the right ventricle, as well as during pacing at 200 beats/min ([1] = 107 ± 13.2 ml/kg per min; [2] = 73.8 ± 17. 5 ml/kg per min; and [3] = 78.3 ± 23.6 ml/kg per min), Tricuspid regurgitation did not change under any of the conditions tested. Intrauterine transvenous cardiac pacing was successfully achieved. Insertion of the pacing lead into the right ventricle decreased the ventricular output without increasing tricuspid valve regurgitation.     

组织多普勒技术对糖尿病妊娠胎儿心功能的评价

目的 通过组织多普勒技术测量胎儿二、三尖瓣环的运动速度来评价胎儿的心肌收缩与舒张功能，以此评估妊娠糖尿病胎儿心脏功能的损害程度。方法 妊娠糖尿病22例，正常对照组30例，使用组织多普勒测量胎儿心脏二尖瓣及三尖瓣环处的运动速度，并使用M型超声测量左右心的射血分数EF。结果 两组胎儿心肌舒张功能随孕周增长而增加，收缩功能与孕周无关。妊娠糖尿病胎儿心肌的舒张及收缩功能均比正常妊娠降低，射血分数高于正常。结论 组织多普勒技术是一项评价病理妊娠状态下胎心功能的新技术。     

脉冲多普勒超声对胎儿不同妊周脐带及脑循环动态变化的研究

目的，探讨不同妊周胎儿脐血流及脑血流的变化规律。方法，对４２２例妊娠２１～４２周正常产妇，用脉冲多普勒超声测量其胎儿脐带动脉（ＵＡ）、大脑中动脉（ＭＣＡ）之ＲＩ（阻力指数）与ＰＩ（搏动指数）。结果与结论，ＲＩ与ＰＩ的变化高度一致（ｒ＝０．９７８）（ｐ＜０．００１）。ＵＡ两指数在妊娠２１周时最高，此后逐渐下降至足月（Ｐ＜０．００１）。ＭＣＡ两指数从２１周起先缓慢上升，２９周时达高峰，此后迅速下降至足月（ｐ＜０．００１）。ＵＡ的ＲＩ、ＰＩ与ＭＣＡ的ＲＩ、ＰＩ之比值，从妊娠２１周起迅速下降，２９～３４周间维持较低水平，以后缓慢上升，到妊娠足月时仍明显低于妊娠２１周时水平（Ｐ＜０．００１）。