23例胎儿充血性心衰的多普勒超声心动图诊断

目的 探讨彩色多普勒超声技术诊断胎儿充血性心衰(CHF)，为早期宫内诊断和治疗及疗效评价提供准确依据。方法 经我院检出并诊断23例CHF胎儿及正常对照组30例。结果 (1)其中11例出现中度以上水肿。(2)均示心脏显著肥厚扩大，表现为心胸比例增大，心房、心室的不对称及心室壁肥厚；心室缩短率(FS％)及心输出量(CC())降低(P＜O．O01)。(3)进行性加重的二、三尖瓣返流(MR TR)，5例肺动脉瓣返流。(4)23例胎儿脐动脉PI值明显增高或舒张期血流相消失及大脑中动脉PI值降低；13例出现脐静脉持动性血流，下腔静脉内径增宽及血流频谱改变。结论 应用多普勒超声心动团通过主动脉和肺动脉CO的总和CCO可无创获得心输出量的指标及计算FS以达到量化胎儿心功能的目的，加之可直观地显示胎儿心脏结构，检测瓣膜返流及评价外周血流动力学变化。

Diagnosis of 23 cases fetal congestive heart failure by Doppler ultrasonography

Objective To detect the fetal congestive heart failure(CHF)by colour Doppler Echocardiography.Methods 23 fetus with CHF and 30 control subjects were studied by colour Doppler Echocardiography.Results (1)There were 11 cases fetus with moderate dropsy in the 23 fetus.(2)All fetus were showed severe cardiac hypertrophy,such as increased of cardiothoracic area ratio,dissymmetry of atrial and ventricle,ventricular wall hypertrophy,and decreased of the ventricular shortening fraction(FS)and the total cardiac output of aorta and pulmonary artery(CCO).(3)Aggravating regurgitation of the mitral valve and tricuspid valve.4.All fetus with CHF showed the increased pulsatility index in the umbilical and the decreased pulsatility index in the middle cerebral artery,13 fetus showed abnormal umbilical venous Doppler.Conclusion It can quantify the fetal cardiac function through the CCO and FS,immediacy display the structure of the fetal heart,inspect the regurgitation of the heart valve and evaluate the dynamics change of peripheral blood flow by the echocardiography examination.