区域血流追踪法在超声诊断胎儿肺静脉异位引流中的应用价值

目的探讨区域血流追踪法在超声诊断胎儿肺静脉异位引流中的价值。 方法回顾性选取2015年1月至2019年12月在河北生殖妇产医院进行胎儿超声心动图检查,诊断为肺静脉异位引流的胎儿41例。超声检查胎儿肺静脉时,应用区域血流追踪法,即将肺组织大致分为4个区域,左侧前上部1/2肺野、左侧后下部1/2肺野、右侧前上部1/2肺野、右侧后下部1/2肺野,应用彩色血流技术对41例肺静脉异位引流胎儿4个区域内肺静脉分支进行追踪并定位,观察其近心端与左心房的关系及最终回流部位。 结果41例肺静脉异位引流胎儿,4个区域内肺静脉远端分支分别引流入左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉。36例完全型肺静脉异位引流胎儿4条肺静脉近心端均未汇入左心房,其中34例呈现左心房后方汇聚征。心上型25例肺静脉最终回流入上腔静脉;心内型7例中6例通过冠状静脉窦回流入右心房,1例直接回流入右心房;心下型2例肺静脉回流入门静脉窦;混合型2例,1例左侧肺静脉汇入上腔静脉,右侧肺静脉汇入下腔静脉,1例左侧肺静脉汇入上腔静脉,右侧肺静脉回流入右心房。5例部分型肺静脉异位引流胎儿,1例右上肺静脉直接回流入右心房,2例右上肺静脉回流入上腔静脉,1例右上、右下肺静脉直接回流入右心房,1例左肺静脉变异为3支,最上支经无名静脉回流入上腔静脉。 结论应用区域血流追踪法可使肺静脉分支检查更全面,定位更加精确,有助于提高胎儿肺静脉异位引流的诊断准确性。

Value of regional flow tracing in ultrasonic diagnosis of fetal anomalous pulmonary venous drainage

ObjectiveTo assess the value of tracing the regional pulmonary venous flow in ultrasonic diagnosis of fetal anomalous pulmonary venous drainage (APVD). MethodsForty-one fetuses with APVD diagnosed by fetal echocardiography at Hebei Reproductive Maternity Hospital from January 2015 to December 2019 were selected retrospectively. In ultrasonic examination, the fetal lung was roughly divided into four regions: the left upper 1/2, left lower 1/2, right upper 1/2, and right lower 1/2 lung fields. The pulmonary vein branches in the four regions of 41 fetuses with APVD were tracked and located by Color Doppler Flow Imaging. The relationship between the proximal end of pulmonary vein branches and the left atrium and the final drainage location was observed. ResultsA total of 19 372 fetuses were examined, of which 41 (0.2%) were diagnosed as having APVD without other intracardiac malformations. In the 41 fetuses with APVD, the distal branches of the pulmonary vein in the left upper 1/2, left lower 1/2, right upper 1/2, and right lower 1/2 lung fields returned to the left superior pulmonary vein, left inferior pulmonary vein, right superior pulmonary vein, and right inferior pulmonary vein, respectively. The four pulmonary veins in 36 fetuses with total anomalous pulmonary venous drainage (TAPVD) were not connected to the left atrium, of which 34 showed the "convergence sign" behind the left atrium. Pulmonary veins in 25 cases with supracardiac TAPVD returned to the superior vena cava. There were seven cases of intracardiac type, of which the pulmonary veins returned to the right atrium directly in one case and through the coronary sinus in six cases. The pulmonary veins in two cases with cardiac infracardiac TAPVD returned to the inferior vena cava. There were two cases of mixed type, of which the left pulmonary veins returned to the superior vena cava and the right pulmonary veins returned to the inferior vena cava in one case, and the left pulmonary veins returned to the superior vena cava and the right pulmonary veins returned to the right atrium in another case. There were five cases of partial anomalous pulmonary venous drainage (PAPVD). The right superior pulmonary vein returned to the right atrium directly in one case and the superior vena cava in two cases. Two right pulmonary veins returned to the right atrium in one case. There was variation of three left pulmonary veins in one case, with the superior branch returning to the superior vena cava. ConclusionPulmonary vein branches can be scanned more comprehensively and be positioned more accurately by the application of regional flow tracing, which could help to improve the diagnostic accuracy of fetal anomalous pulmonary venous drainage.