产前超声诊断在胎儿左侧异构中的应用

目的:探讨胎儿左侧异构的产前超声征象及其诊断价值。方法:回顾分析21例产前诊断为胎儿左侧异构的病例资料,对比总结其超声征象与随访结果。结果:21例左侧异构胎儿中,内脏心脏异位16例,先天性心脏病19例(伴心脏传导阻滞5例),下腔静脉离断伴奇静脉异常连接19例,其中两种及两种以上异常诊断胎儿左侧异构的敏感性为90.5%。染色体异常3例,18三体2例,13三体1例。18例终止妊娠,1例胎死宫内,2例存活。结论:产前超声诊断胎儿左侧异构是可行的,重要超声征象是内脏心脏异位、先天性心脏病伴或不伴心脏传导阻滞、下腔静脉离断伴奇静脉异常连接,出现上述两种或两种以上异常可提高该病的诊断敏感性。

Prenatal diagnosis of left isomerism

Objective: To investigate the prenatal ultrasound manifestation of left isomerism and clinical significance. Methods: This was a retrospective review of 21 cases of left isomerism diagnosed in the prenatal and postnatal periods. Results: Among 21 fetuses,16 had different types of viscerocardiac heterotaxy,19 had cardiac defects( with 5 heart block),19 had an interrupted inferior vena cava with azygous continuation,in which two or more anomalies detected left isomerism with the sensitivity of 90.5%.Abnormal karyotype was found in 3 fetuses,2 were trisomy 18,1 was trisomy 13.18 cases underwent termination of pregnancy,1 case died in utero,2 survived.Conclusion: Prenatal diagnosis of left isomerism is feasible.Important sonographic manifestations are viscerocardiac heterotaxy,cardiac defect,with or without heart block and an interrupted inferior vena cava with azygous continuation,and two or more above anomalies can improve the detection sensitivity of left isomerism.