圆锥动脉干畸形产前超声诊断与误诊分析

目的:探讨产前超声诊断圆锥动脉干畸形的难点及误诊原因分析.方法:对36例胎儿圆锥动脉干畸形的病例资料进行回顾分析,将产前诊断结果与产后新生儿超声心动图或引产后解剖结果进行对比.分析产前诊断结果的偏差,总结产前超声诊断圆锥动脉干畸形的经验.结果:产前超声诊断法洛四联症9例,右室双出口8例,肺动脉闭锁伴室间隔缺损6例,完全型大动脉转位4例,矫正型大动脉转位1例,永存动脉干7例.产前诊断9例法洛四联症中2例产后手术证实为右室双出口,产前漏诊法洛四联症1例,产前诊断符合率70％(7/10);8例右室双出口中2例引产后证实为法洛四联症,产前诊断符合率75％(6/8).6例产前诊断肺动脉闭锁伴室间隔缺损,1例引产后证实为永存动脉干,产前诊断符合率83.3％(5/6);4例完全型大动脉转位,引产后证实全部正确,产前诊断符合率100％(4/4);1例矫正型大动脉转位产后超声心动图证实正确,产前诊断符合率100％(1/1);产前诊断永存动脉干7例,2例引产后证实为肺动脉闭锁伴室间隔缺损,1例引产后证实为主动脉闭锁伴室间隔缺损,产前诊断符合率57.1％(4/7),产前无法分型2例,产前诊断分型符合率50％(2/4).结论:产前超声心动图对圆锥动脉干畸形的检出具有重要的价值,产前超声心动图检查中,认真分析动态图回放、掌握CTA血流动力学改变对提高圆锥动脉干畸形产前诊断准确性有重要意义.

Analysis of antenatal ultrasonic diagnosis and misdiagnosis in cones-arteriotruncus malformation

Objective:To discuss the causes of misdiagnosis and the difficulties in the antenatal ultrasonic diagnosis for cones-arteriotruncus malformation.Methods:The clinical materials of 36 fetuses with cones arteriotruncus malformation were analyzed retrospectively.The antenatal diagnosis and postnatal newborn ultrasonic cardiogram or anatomy results after labor induction were compared.The causes of antenatal misdiagnosis were analyzed,and the experiences obtained from antenatal ultrasonic diagnosis of cones-arteriotruncus malformation were studied.Results:The antennal diagnosis were tetralogy of Fallot (9 patients),double outlet right ventricle (8 patients),pulmonary artesia in combination with ventricular septal defect (6 patients),complete transposition of great arteries (4 patients),corrected transposition of great arteries (1 patient) and with persistent truncus arteriosus (7 patients).In the 9 patients with antenatal diagnosis as Tetralogy of Fallot,the postnatal diagnoses were proven as double outlet of right ventricle in 2 patients and one patient had the antenatal diagnosis of tetralogy of Fallot missed.The antenatal diagnosis accuracy was 70％ (7/10).Of the 8 patients with the antenatal diagnosis as double outlet right ventricle,two patients were proven as tetralogy of Fallot and the antenatal diagnosis accuracy was 75％ (6/8).In 6 patients with ventricular septal defect in combination with pulmonary artery atresia,one patient was proven with persistent truncus arteriosus after induced labor,the antenatal diagnosis accuracy was 83.3％ (5/6).The antenatal diagnosis of 4 patients with complete transposition of great arteries were all proven correct,the antenatal diagnosis rate was 100 ％ (4/4).Postnatal ultrasonic cardiogram of one patient showed the antenatal diagnosis as corrected transposition of great arteries was right,the accuracy was 100 ％ (1/1).In 7 patients with antenatal diagnosis as persistent truncus arteriosus,2 patients were diagnosed as ventricular septal defect in combination with pulmonary artery atresia after induced labor and one patient was proven with ventricular septal defect in combination with aortic atresia.The antenatal diagnosis accura cy was 57.1％ (4/7).Antenatal classification of heart defect could not be assessed in 2 patients,the accuracy was 50％ (2/4).Conclusion:Antenatal ultrasonography provides important value in the antenatal diagnosis of cones-arteriotruncus mal formation.Precise analysis of the playback dynamic images and understanding of the hemodynamic changes of CTA are im portant to improve the accuracy of prenatal diagnosis of cones arteriosus malformation.