四腔心和流出道切面在常规产前先天性心脏畸形筛查中的意义

目的评价四腔心和流出道切面在胎儿先天性心脏畸形（congenital heart defect,CHD）筛查中的价值;探讨常规胎儿CHD筛查的必要性。方法采用彩色多普勒超声诊断仪,在显示四腔心切面的基础上,根据胎儿体位不同,选择相应的矢状、冠状或横切显示左、右室流出道。根据CHD病理特征和先心高危因素有无,把胎儿CHD分为简单型和复杂型,CHD胎儿分为高危因素组和非高危因素组。结果四腔心切面在产前诊断复杂型CHD和简单型CHD中的敏感度分别为58.3%和23.5%;四腔心和流出道切面联合应用在产前诊断复杂型CHD和简单型CHD中的敏感度分别为87.5%和29.4%。41例CHD中,高危因素组13例,非高危因素组28例。结论四腔心和流出道切面联合应用对产前诊断复杂CHD有较高的敏感性,对简单型CHD的敏感性低;常规产前CHD筛查是提高胎儿CHD诊断率的关键。

Importance of Four-chamber and Outflow Tract Views in Prenatal Screening for Congenital Heart Defects

Objective To investigate the value of the four-chamber and outflow tract views in prenatal screening for congenital heart defects(CHD)and to discuss the significance of routine prenatal fetal echocardiography.Methods Four-chamber and outflow tract views were used to detect fetal hearts,The outflow tract view demonstrated transverse,sagittal or coronal orientation according to the fetal position.Fetal CHD was classified into simple and complex forms pathologically.Fetuses with CHD were also classified into high-risk factors group and non-high risk factors group.Results The sensitivity of unitary four-chamber view and combined with outflow tract view in screening complex form CHD were 58.3% vs 87.5%(P<0.05).No difference was found of these two methods for simple CHD,23.5% vs 29.4%.Among 41 CHD,13 were in high-risk factors group and 28 were in non-high risk factors group.Conclusions Combination of four-chamber and outflow tract views has a high sensitivity in screening complex CHD.Routine prenatal echocardiography is necessary for prenatal screening of CHD.