超声检查胎儿肺动脉瓣缺如的临床分析

目的探讨产前超声诊断胎儿肺动脉瓣缺如的临床价值。方法回顾性分析8例经引产后尸检证实的肺动脉瓣缺如胎儿的声像图资料及尸检结果,总结其声像图特征及病理改变。结果 8例胎儿右室流出道切面均显示主肺动脉扩张与肺动脉瓣环狭窄,呈"沙漏状"征象,无肺动脉瓣叶回声及启闭活动,其中5例主肺动脉及左、右肺动脉呈瘤样扩张;彩色多普勒均显示肺动脉瓣口往返的五彩镶嵌血流信号,频谱多普勒显示肺动脉瓣口全收缩期湍流和全舒张期反流频谱。8例肺动脉瓣缺如胎儿中3例伴发法洛四联症,2例伴发三尖瓣闭锁、右心发育不良,伴发右室双出口、三尖瓣下移畸形各1例,1例为孤立性肺动脉瓣缺如。伴发法洛四联症及右室双出口的4例胎儿均显示室间隔缺损、动脉导管缺如,另4例胎儿室间隔完整并显示动脉导管。结论产前超声诊断胎儿肺动脉瓣缺如具有重要临床价值,应注意其合并症的诊断。

Study on prenatal ultrasound in diagnosing fetal absent pulmonary valve

Objective To study the clinical value of prenatal ultrasound in diagnosing fetal absent pulmonary valve. Methods Echocardiography findings and autopsy results of 8 cases of fetuses with the absence of pulmonary valve con- firmed by autopsy were retrospectively analyzed, the sonographic features and pathological changes were summarized. Re- suits Eight fetuses showed that pulmonary valve ring stenosis, no open and close movement of leaflets. Eight fetuses had shown dilation pulmonary artery with severe dilatation of the main pulmonary artery and its branches in 5 cases. Color Doppler showed the colorful mosaic blood flow through the pulmonary valve ring back and forth, spectral Doppler showed pansystolic turbulence and pandiastolic reflux spectrum. There were 3 cases associated with tetralogy of Fallot, 2 cases of tricuspid atresia with right ventricular hypoplasia, associated with double outlet right ventricle, Ebstein malformation in 1 case, 1 case of isolated pulmonary valve absence. Four cases of associated with tetralogy of Fallot and double outlet right ventricle were shown ventrieular septal defect and absent ductus arteriosus,other four cases were shown intact ventricular septum and ductus arteriosus. Conclusion Prenatal ultrasound is of great clinical value in diagnosing fetal absent pulmona- ry valve, and should pay attention to the complications.