胎儿超声心动图在产前诊断完全型肺静脉异位引流中的应用

目的探讨完全型肺静脉异位引流（TAPVC）胎儿超声心动图特征及产前诊断临床意义。方法对2010年1月至2013年1月在南京医科大学附属苏州医院超声中心经产前及产后超声心动图或引产后尸检确诊的13例TAPVC胎儿超声心动图特征及产前诊断的临床意义进行总结分析。结果产前超声诊断12例TAPVC,其中心上型7例,心下型3例,心内型2例。超声表现为：胎儿左心稍小于右心,卵圆孔较大,心房水平右向左分流丰富,左心房与降主动脉距离增宽,左心房顶部光滑,无肺静脉开口,其后方可见共同肺静脉干,追踪共同肺静脉干走行可显示引流部位,相应引流部位血管内径扩张。产前超声漏诊1例,经产后超声心动图确诊为心内型TAPVC。13例TAPVC胎儿中3例为单发畸形（3/13）,10例合并其他心内或心外畸形（10/13）。结论 TAPVC有特征性胎儿超声心动图表现,胎儿超声心动图是诊断TAPVC的可靠方法;产前诊断TAPVC有利于孕妇作出优生优育选择,使胎儿出生后得到及时治疗。

The application of fetal echocardiography in prenatal diagnosis of total anomalous pulmonary venous connection

Objective To investigate the echocardiographic features and clinical significance of prenatal diagnosis of total anomalous pulmonary venous connection（TAPVC）.Methods Fetal echocardiographic images of 13 fetuses with TAPVC confirmed by pathology or postnatal echocardiography were reviewed.Echocardiographic features and clinical significance of prenatal diagnosis of TAPVC were summarized.Results Twelve fetuses with TAPVC were diagnosed prenatally by fetal echocardiography,including seven cases of supracardiac type,three cases of infracardiac type and two cases of intracardiac type.The common echocardiographic characteristics of 12 fetuses with TAPVC included slightly size discrepancy of left heart and right heart,large foramen ovale with increased shunting at the atrial level,increased distance between left atrium（LA） and descending aorta,absent insertions of pulmonary veins in the LA,presence of pulmonary venous confluence on the top of LA and dilatation of vessels where pulmonary venous confluence drained.One case was missed prenatally and intracardiac type TAPVC was diagnosed by postnatal echocardiography.Among the 13 cases,three were isolated and the other ten were all in association with other abnormalities.Conclusions There are fetal echocardiographic characteristics of TAPVC.Fetal echocardiography plays an important role in prenatal diagnosis of TAPVC.