超声心动图在早孕期超声软指标阳性胎儿中的应用

目的探讨早孕期（11~13^＋6周）胎儿超声心动图在超声软指标阳性胎儿中诊断先天性心脏病的应用价值。 方法对133例超声软指标阳性的胎儿行早孕期胎儿超声心动图检查，重点观察心脏四腔观及三血管气管观，并尽可能获取更多其他的胎儿心脏超声切面。对怀疑心脏异常者于2~4周后复查胎儿超声心动图，确诊后引产的胎儿行病理检查；余胎儿分别于中孕期和新生儿期复查心脏超声。 结果早孕期胎儿超声心动图四腔观显示率为78%（104/133，78%），三血管气管观显示率为77%（103/133，77%），共提示10例先天性心脏病，失访1例，余9例均引产经病理证实为复杂先天性心脏病，其中正确诊断7例，误诊2例，另于随访中发现漏诊2例。早孕期胎儿超声心动图对诊断复杂先天性心脏病的准确率为63.6%（7/11，63.6%）。 结论早孕期超声心动图能对一部分复杂先天性心脏病作出提示性诊断，为临床决策提供重要信息。

The use of echocardiography in fetuses with ultrasound soft markers at first trimester

ObjectiveTo investigate the value of fetal echocardiography in the diagnosis of congenital heart disease at first trimester in fetuses with ultrasound soft markers. MethodsEarly fetal echocardiography was performed in 133 fetuses with ultrasound soft markers. Special attention was paid at four-chamber view and three vessels and trachea view. Additional fetal echocardiographic planes were also obtained as much as possible. Follow-up was taken 2-4 weeks after cardiac abnormality was suspected. Based on the fingdings of follow-up echocardiography, autopsy was conducted for the fetuses with confirmed diagnosis. On the other hand, routine fetal echocardiography at second trimester and neonatal echocardiography after birth were performed for the fetuses without definite diagnosis. ResultsFour-chamber view and three vessels and trachea view were successfully achieved in 78% (104/133, 78%) and 77% (103/133, 77%) cases, respectively. Ten cases of congenital heart disease (CHD) were suspected by early fetal echocardiography. One case was lost at follow-up and the rest 9 cases were confirmed by autopsy. Among the 9 cases, 7 were diagnosed correctly and 2 were misdiagnosed. Additional 2 cases of CHD were detected during follow-up. The accuracy of early fetal echocardiography in the diagnosis of complex congenital heart disease was 63.6% (7/11, 63.6%). ConclusionEarly fetal echocardiography is feasible and most complex CHDs can be detected at early stage of pregnancy.