胎儿心律失常的超声心动图检测及其临床意义

目的 探讨超声心动图检测对胎儿心律失常的诊断价值及临床意义。方法 采用超声心动图对725例胎龄16-41周临床疑诊为心律失常或存在其他异常的胎儿进行检测。结果 共检出胎儿心律失常90例。其中,期前收缩72例(房性期前收缩65例,室性期前收缩7例),心动过缓9例,心动过速6例,2:1房室传导阻滞2例,心房扑动1例。4例心动过缓胎儿并发先天性心血管畸形患者,2例在随访过程中死于宫内(尸体解剖证实为单心室伴肺动脉瓣狭窄1例,心脏横纹肌瘤1例),2例终止妊娠(尸体解剖证实为二尖瓣闭锁1例,共同房室通道1例)。1例胎龄38周心房扑动胎儿经吸氧及严密监护24h后,心律失常无缓解,立即行剖宫产术,出生后应用西地兰后心律转为窦性。其余85例胎儿心律失常均为阵发性,不伴有胎儿心脏形态、结构畸形及胎儿水肿,均足月出生,出生后听诊均未闻及心脏杂音及心律失常。结论 胎儿超声心动图是产前检查胎儿心律失常的可靠的无创性影像技术,其应用有助于早期检出并指导心律失常胎儿的处理。

Application of fetal echocardiography in detection of fetal arrhythmia and its clinical significance

OBJECTIVE: To investigate application of fetal echocardiography in diagnosis of fetal arrhythmia and its clinical significance. METHODS: Fetal echocardiography was performed on 725 fetuses for evaluation of fetal heart structures and arrhythmias. Two-dimensional, M-mode, Color M-mode and pulsed Doppler echocardiography were used. RESULTS: Ninety fetuses were documented with fetal arrhythmia, the commonest fetal arrhythmia encountered in 72 cases extrasystole was (65 atrial extrasystoles, 7 ventricular extrasystoles), followed by bradycardia in 9 cases, tachycardia in 6 cases, 2:1 atrioventricular block in 2 cases, atrial flutter in 1 case. There were 4 fetuses with arrhythmias and structural heart diseases: 2 fetuses were found died in uterus within two-week follow-up (1 with single ventricle and pulmonary stenosis, 1 with cardiac rhabdomyoma, fetal echocardiographic findings were confirmed at autopsy), another 2 cases (1 with mitral atresia and 1 with atrioventricular canal defect, autopsy confirmed the fetal echocardiographic diagnoses) received termination of pregnancy later. One 38-week fetus with atrial flutter underwent cesarean section, neonatal ECG confirmed the arrhythmia, and Cedilanid D induced successful conversion. All the other 85 fetuses were with intermittent arrhythmia, normal heart structures, and had no fetal hydrops. After receiving routine treatment, all of them had term deliveries and follow-up monitoring showed normal neonatal heart rhythms (auscultation). CONCLUSIONS: Fetal echocardiography is the main diagnostic tool for prenatal evaluation of fetal arrhythmias. The outcomes of the vast majority of fetal arrhythmias are benign, especially for fetuses with extrasystoles. Their arrhythmias are always well tolerated and disappear during the perinatal period. Fetuses with intermittent arrhythmias without structural heart malformations, fetal hydrops or heart failure, can be followed up with routine prenatal care without the need for special intervention.