彩色多普勒超声心动图评价胎儿肿瘤与充血性心衰

目的应用多普勒超声心动图探讨胎儿肿瘤与充血性心衰（CHF）的病变机制及其相关性。方法对我院诊断的21例胎儿肿瘤行胎儿产科常规和胎儿超声心动图检查及心功能检测。结果21例胎儿肿瘤中心脏肿瘤12例；颈部水囊瘤4例；肺囊腺瘤2例；骶尾部畸胎瘤2例；肝脏肿瘤1例。其中8例出现胎儿水肿，同时出现心脏肥厚扩大，表现为心胸面积比增大，以及心房、心室的不对称增大或心肌肥厚，心室缩短率（FS）及心输出量（CCO）降低（P〈0．001），伴中至重度二、三尖瓣反流；其中3例出现肺动脉瓣反流；3例出现脐静脉搏动性血流，腔静脉内径增宽及血流频谱改变。结论应用彩色多普勒超声心动图诊断胎儿肿瘤，可探讨与CHF的相关因素。通过主动脉和肺动脉输出量（CO）的总和CCO可无创获得心输出量的指标及计算聆以达到量化胎儿心功能的目的，并可评价心内及外周血流动力学变化。

Evaluation of fetal tumor and congestive heart failure by Doppler echocardiography

Objective To investigate the correlation between fetal tumor and congestive heart failure(CHF), and explore possible mechanisms of CHF.Methods Twenty-one fetuses with tumor underwent echocardiographic fetal cardiac function examination. Results Among the 21 fetuses, tumors of the heart were identified in 12 cases, nuchal cystic hygroma in 4, congenital cystic adenomatoid malformation of the lung in 2, sacrococcygeal teratoma in 2, and hepatic tumor in one.Hydrops fetalis developed in 8 , with decreased ventricular fractional shortening(FS%) and combined cardiac output(CCO)(P<0.001), increased fetal cardiothoracic ratio, and asymmetrical enlargement of atrium and ventricle or myocardial hypertrophy.Medium to severe regurgitation of mitral valve and tricuspid valve occured in 18 cases, and regurgitation of pulmonary valve in 5 cases.Conclusion To fetuses with tumors, Doppler echocardiography is valuable in quantifying fetal cardiac function by calculating such indexes as FS and CCO,and assessing both intracardiac and peripheral hemodynamics.