胎儿心脏连续扫查方法在产前诊断圆锥干畸形中的意义

目的探讨胎儿心脏连续扫查方法在产前诊断圆锥干畸形中的价值。方法根据胎儿的不同体位，应用超声对1067例孕18-26周的高危胎儿进行横向、矢状或冠状连续心脏扫查，扫查过程中将主、肺动脉排列次序或内径的改变、交叉结构的消失或不显示作为圆锥干畸形存在的特征性改变，同时对有上述特征性改变的胎儿作进一步的超声心动图检查以明确诊断。结果1067例胎儿失访17例，余1050胎儿中有上述特征性改变的胎儿33例，进一步详细行超声心动图检查后产前诊断圆锥干畸形21例，其中法洛四联症9例，大动脉转位9例，共同动脉干2例，右室双出口1例；生后超声或尸检证实产前漏诊法洛四联症1例，大动脉转位1例，右室双出口误诊为法洛四联症1例。胎儿心脏连续扫查方法在产前诊断圆锥干畸形的敏感性、特异性、阳性预测值和阴性预测值分别为91．3％、98．8％、63．6％和99．8％，产前诊断准确率为87．0％。结论胎儿心脏连续扫查过程中主、肺动脉排列次序或内径改变、交叉结构的消失或不显示对预测胎儿圆锥干畸形有较高的敏感性和特异性，结合不同类型圆锥干畸形的病理解剖特征进一步作超声心动图检查可提高圆锥干畸形的产前诊断率。

The clinical value of sequential fetal heart scan in prenatal diagnosis of conotruncal defects

Objective To discuss the clinical value and determine the specificity and sensitivity of sequential fetal heart scan in diagnosing fetal conotruncal defects. Methods One thousand and sixty-seven fetuses with high risk factors were included. The fetal heart was scaned in transverse, sagittal or coronal orientation according to the fetal position. Abnormal in arrangement, size, course or the non-displaying of pulmonary artery and aorta represented for the features of conotruncal defects. Further detailed echocardiography was performed for prenatal diagnosis by experts in obstetric ultrasonography. Results Among the 1067 fetuses,1050 were followed up to one week after birth. Among them,33 fetuses showed above features during sequential fetal heart scan and 21 were diagnosed as conotruncal defects after detailed echocardiography,including 9 transposition of the great vessels,9 tetralogy of Fallot, 2 truncus arteriosus and 1 double outlet respectively. Postnatal echocardiography or autopsy confirmed that 1 tetralogy of Fallot and 1 transposition of the great vessels were missed and 1 double outlet was misdiagnosed as tetralogy of Fallot prenatally. The sensitivity, specificity, positive predictive valve, negative predictive value of these features to indicate conotruncal defects were 91.3%, 98.8%, 63.6% and 99.8% respectively. Prenatal diagnosis rate was 87. 0%. Conclusions Abnormal in arrangement, size, courses or nondisplaying of pulmonary artery and aorta during sequential fetal heart scan has a high specificity and sensitivity in predicating conotruncal defects. Combining with pathologicoanatomic features of different countruncal defects, further detailed echocardiography could improve the prenatal diagnosis rate.