超声心动图检测卵圆孔和卵圆孔瓣在诊断胎儿房间隔异常中的应用研究

目的超声心动图观察胎儿卵圆孔、卵圆孔瓣的特征，探讨超声诊断胎儿房间隔异常的临床应用价值。方法随机对515例孕24～42周正常胎儿的卵圆孔、卵圆孔瓣的多普勒超声特征进行分析；对440例胎儿心血管畸形高危因素的孕妇进行胎儿心动图专项检查，对胎儿房间隔回声异常者进行胎儿尸体解剖或分娩后超声复查对照。结果超声心动图对515例正常胎儿卵圆孔和卵圆孔瓣的显示率为98．6％（508／515），卵圆孔径（5．42±1．30）mm；卵圆孔收缩期血流速度（0．45±0．93）m／s、舒张期血流速度（0．29±0．72）m／s。440例胎儿心血管畸形高危因素的孕妇中超声检出23例胎儿房间隔回声异常，其中卵圆孔瓣消失10例、断裂3例、增大10例，其卵圆孔径（9．64±2．58）mm，明显大于正常组（P〈0．05）；23例卵圆孔和卵圆孔瓣显示异常的胎儿，经尸体解剖或分娩后超声复查确定21例有房间隔发育异常或伴有其他畸形，假阳性2例。结论超声检测卵圆孔和卵圆孔瓣对产前诊断胎儿房间隔异常具有重要价值。

Application of echocardiography in diagnosis of fetal atrial septum abnormality with foramen ovale and valve of foramen ovale detection

Objective To observe the characteristics of fetal foramen ovale and valve of foramen ovale by echocardiography,and to explore the clinical value of ultrasound in diagnosis of fetal atrial septum abnormality. Methods Five hundred and fifteen patients with 24 to 42 gestationa weeks were enrolled in this study, and the characteristics of fetal foramen ovale and the valve of foramen ovale were analyzed by color Doppler ultrasound. Four hundred and forty patients with high risk of fetal cardiovascular malformation were examined by fetal echocardiography, and the results were compared with fetus autopsy or neonatal echocardiography. Results The display rate of foramen ovale and the valve of foramen ovale in 515 cases of normal fetal was 98.6% （508/515） , the diameter of foramen ovale was （5.42 ± 1.30） mm, the blood flow velocity of foramen ovale in systolic phase was （0.45 ± 0. 93 ） m/s, and in diastolic phase was （0.29 ± 0.72 ） m/s. Twenty - three cases with abnormal echo in atrial septum were detected by ultrasound in 440 patinets with high risk. of fetal cardiovascular malformation. The valve of foramen ovale disappeared in 10 cases, disrupted in 3 cases and increased in 10 cases, the diameter of foramen ovale was （9.64 ± 2.58 ） mm , which was significantly higher than that in normal group （ P 〈 0.05 ）. Among the 23 abnormal cases ,21 cases were atrial septum development abnormity or combined with other abnormality confirmed by fetus autopsy or neonatal echocardiography, and 2 cases were false positive. Conclusion Foramen ovale and valve of foramen ovale detection has important value in prenatal diagnosis of fetal atrial septum abnormality by ultrasound.