组织多普勒成像在胎儿心律失常中的应用研究

目的 探讨组织多普勒成像（TDI）在胎儿心律失常检测中的临床应用价值。方法对孕龄为16～41周的36例正常胎儿应用超声心动图观察心房与心室的收缩与舒张变化特点，并对M型TDI及TDI运动速度曲线进行观察分析；同时对29例经M-型及多普勒超声心动图确立诊断的心律失常胎儿（孕龄17～37周）的二尖瓣环（或三尖瓣环）TDI运动速度曲线进行观察，并与二尖瓣口（或三尖瓣口）血流流速曲线进行对照分析。由两名经验丰富的医师独立应用TDI对心律、心率及心律失常的分型进行评估，并对两者评估结果的一致性进行Kappa检验。结果 所有65例胎儿均获得清晰的二维TDI、M型TDI及二尖瓣环（或三尖瓣环）TDI速度曲线。29例心律失常胎儿，通过检测二尖瓣环（或三尖瓣环）TDI速度曲线，可以对其心律失常作出可靠诊断并进行分型，两观察者在评估TDI对心率测定、心律及心律失常的诊断及分型等方面均完全一致。结论 组织多普勒成像可以较准确地诊断胎儿心律失常。

Application of Doppler tissue imaging in diagnosis of fetal arrhythmias

Objective To assess the feasibility of Doppler tissue imaging(TDI) evaluation of arrhythmias in the fetuses. Methods Thirty-six normal fetuses between 16 to 41 weeks of gestation were studied to identify color- TDI patterns consistent with the various phases of the cardiac cycle. The characteristics of TDI of mitral (or tricuspid) annulus spectrum of 29 fetuses with arrhythmias were compared with the results obtained with M-mode and/or diastolic mitral color Doppler spectrum in evaluating fetal arrhythmias. The ability and diagnose accuracy of TDI were further evaluated independently by two observers with experience in fetal echocardiography. The agreement between them was assessed with the Kappa statistics. Results TDI examinations including 2D-TDI, M-mode TDI and PW-TDI were acceptably reproducible in all 65 fetuses. The TDI spectrum of mitral(or tricuspid) annulus were readily analyzed and yielding diagnostic results in all 29 fetuses with arrhythmias.The ability and diagnose accuracy of DTI were evaluated independently by 2 observers indicated satisfactory agreements.Conclusions TDI evaluation of the fetal heart is feasible and reproducible, this technique may aid in the diagnosis and understanding of fetal arrhythmias.