右位主动脉弓胎儿超声心动图诊断分析

目的总结右位主动脉弓胎儿超声心动图表现及其血管特征.方法对26例超声心动图诊断为右位主动脉弓胎儿的超声心动图表现进行总结分析并观察其临床结局.结果26例右位主动脉弓胎儿中12例为孤立右位主动脉弓,2例为双主动脉弓,2例合并永存左上腔静脉,7例合并法洛四联症,3例合并永存动脉干.26例右位主动脉弓胎儿超声心动图均在上纵隔三血管气管观作出诊断.其中21例为右位主动脉弓合并迷走左锁骨下动脉、左位动脉导管,形成围绕气管食管的“U”字形血管环;2例双主动脉弓形成围绕气管食管的“O”字形血管环;3例无上述典型超声心动图图像特征.26例中12例活产儿经产后超声心动图或X线检查证实为右位主动脉弓;2例双主动脉弓经外院胎儿磁共振检查证实为右位主动脉弓;10例合并复杂先天性心脏病的胎儿均引产(6例尸体解剖检查证实为右位主动脉弓,4例未行尸体解剖检查);2例失访.结论胎儿右位主动脉弓有特征性超声表现,上纵隔三血管气管观可作为诊断胎儿右位主动脉弓的主要切面观;右位主动脉弓可孤立存在或同时合并其他心脏畸形.

Echocardiographic diagnosis and analysis of fetal right aortic arch

Objective To explore the echocardiographic features and the vascular characters of fetal right aortic arch.Methods Echocardiographic features of fetal right aortic arch in 26 cases detected by prenatal echocardiography were analyzed retrospectively.The clinical outcome of right aortic arch was observed also.Results The 26 cases had fetal right aortic arch including 12 cases with isolated right aortic arch,two cases with double aortic arch,two cases with persistent left superior vena cava,seven cases with tetralogy of Fallot and three cases with common arterial trunk.Diagnosis of right aortic arch was made by three-vessel trachea view on fetal echocardiography.Twenty-one cases were right aortic arch with aberrant left subclavian artery and formed U-shaped vascular rings.Two cases of double aortic arch formed O-shaped vascular rings.The other three cases did not have the typical echocardiographic images.In the 26 cases,12 cases were followed up to birth and were confirmed by postnatal echocardiography or X-ray examination.Two cases of double aortic arch were comfermed by MRI examination.Ten cases with complex congenital heart disease were induced abortion(six cases were confirmed by autopsy,four cases did not perform autopsy).Two cases were lost in follow-up.Conclusions Fetal right aortic arch has the characteristic echocardiographic appearances.Three-vessel trachea view plays an important role in the diagnosis of fetal right aortic arch.Fetal right aortic arch can be an isolated lesion or in association with other cardiac malformations.