胎儿Ⅲ＆#176;房室传导阻滞产前超声心动图分析

目的：总结Ⅲ°房室传导阻滞（CAVB）胎儿超声心动图特征。方法应用二维超声、M型超声及多普勒技术对10例Ⅲ°房室传导阻滞胎儿进行超声心动图检查，观察胎儿心房与心室节律及其对应关系，同时观察二尖瓣、左心室流入道及流出道、静脉导管血流频谱，并对胎儿心脏大小、心功能、房室瓣反流及心包积液等心脏结构进行观察，对Ⅲ°房室传导阻滞胎儿超声心动图特征进行总结分析。结果二维超声心动图检查提示10例Ⅲ°房室传导阻滞胎儿中2例存在心内外畸形，8例无明显心内外畸形。Ⅲ°房室传导阻滞胎儿M型超声心动图特征为房室节律分离，心房节律保持在正常范围而心室节律缓慢，多普勒超声心动图特征为二尖瓣频谱提示E峰频率缓慢，A峰频率明显快于E峰频率，E、A峰无固定对应关系。胎儿超声心动图检查提示，孕妇就诊时10例胎儿中6例心脏扩大，5例心功能不全，6例房室瓣反流，7例心包积液。超声心动图检查后10例孕妇均选择引产。结论Ⅲ°房室传导阻滞是对胎儿心功能有重要影响的缓慢型心律失常，预后不佳。M型超声结合多普勒技术可对Ⅲ°房室传导阻滞胎儿进行诊断及鉴别，对临床干预治疗及判断胎儿预后有重要意义。

Diagnosis of fetal complete atrioventricular block with echocardiography

Objective To evaluate the application of M-mode echocardiography and Doppler echocardiography in diagnosing complete atrioventricular block （CAVB） in fetus. Methods M-mode and Doppler echocardiography were used to screen the fetuses and bradycadia was established as CAVB in 10 cases. Atrial and ventricular rhythm was measured by M-mode echocardiography. Flow of mitral valve, left ventricular in-flow and out-flow tract, venous duct was measured by Doppler echocardiography. The characteristics and prognoses of CAVB fetus were compared and analyzed. Results CAVB was established as independence in rhythm of atrium and ventricle. The rhythm of alrium could be in normal range, while the rhythm of ventricle should be slower than normal. Enlarged chambers were observed in 6 cases, cardiac dysfunction in 5 cases, and pericardial effusion in 7 cases. Tricuspid regurgitation and mitral regurgitation existed in 5 and 1 case, respectively. All of the CAVB fetus in this study underwent abortions. Conclusions Fetal echocardiography is proven to be a useful tool to diagnose CAVB, which greatly influenced the cardiac function in fetuses. Clear diagnosis as early as possible is crucial to the treatrnent of CAVB fetus.