超声心动图在卵圆孔通道血流受限合并心功能异常产前诊断中的应用价值

目的探讨超声心动图在单纯卵圆孔通道血流受限（FOCR）合并心功能异常胎儿产前诊断及预后评估中的应用价值。 方法回顾性选取2018年10月至2020年5月在河北生殖妇产医院检查，产前超声心动图诊断为单纯FOCR且心血管整体评分（CVPS）提示心功能异常的胎儿16例，分析其初诊、分娩前及出生后的超声心动图特征、CVPS及心功能变化，并随访其妊娠结局和预后。 结果14例表现为卵圆孔内径或卵圆孔通道有效分流口内径＜3 mm，2例表现为卵圆孔内径/房间隔总长度＜0.33。16例胎儿分娩前均表现为右心房与左心房横径比（RA/LA）、右心室与左心室横径比（RV/LV）、主肺动脉与升主动脉内径比（MPA/AAO）比值增大，且随孕龄增大而增大，卵圆孔通道分流流速（V-FO）＞40 cm/s。16例胎儿中，14例初诊FOCR时CVPS为8~9分，2例初诊未发现心功能异常，CVPS为10分。16例胎儿分娩前，11例表现为轻度心力衰竭，CVPS为8~9分；5例表现为中度心力衰竭，CVPS为6~7分。9例分娩前CVPS较初诊FOCR时减低。16例胎儿出生后，1例于新生儿期死亡；余15例均存活。存活患儿中13例复查超声心动图，心脏结构正常；1例分娩前CVPS为6分，出生后复查可疑心肌病；1例分娩前CVPS为8分，出生后复查不除外原发性肺动脉高压。 结论超声心动图在FOCR诊断及评估中具有重要价值；应用超声心动图进行CVPS评分可动态观测并评估胎儿心功能变化，对评估胎儿宫内情况及指导分娩时机具有重要意义。

Application value of fetal echocardiography in prenatal diagnosis of foramen ovale channel restriction combined with cardiac dysfunction

ObjectiveTo assess the value of fetal echocardiography in the prenatal diagnosis and prognostic evaluation of fetuses with simple foramen ovale channel restriction (FOCR) combined with cardiac dysfunction. MethodsSixteen fetuses diagnosed as having simple FOCR by prenatal echocardiography and cardiac dysfunction by cardiovascular profile score (CVPS) at Hebei Maternity Hospital from October 2018 to May 2020 were analyzed retrospectively. Their echocardiographic features and changes of cardiac function were dynamically observed to guide timely delivery, and the pregnancy outcome and prognosis were followed. ResultsAmong the included fetuses, 14 showed the inner diameter of the foramen ovale or the effective shunt of the foramen ovale channel＜3 mm, and 2 had an inner diameter of the foramen ovale/the total length of the atrial septum＜0.33. Prenatally, the ratios of RA/LA, RV/LV, and MPA/AAO increased with gestational age, and V-FO was＞40 cm/s in all the 16 fetuses. Before delivery, all the 16 fetuses showed decreased CVPS, with 8-9 in 11 fetuses and 6-7 in 5. After delivery, 1 fetus died of acute respiratory distress syndrome in the neonatal period, and the other 15 fetuses survived without intrauterine fetal death. Postpartum reexamination revealed a normal heart in 13 fetuses, suspected cardiomyopathy in 1, and non-excluded primary pulmonary hypertension in 1. The abnormal indexes of CVPS in the 16 fetuses mainly included massive holosystolic tricuspid regurgitation, increased C/T, decreased FS in the left or right ventricle, abnormal spectrum of venous catheter, pericardial effusion, and pleural effusion. The CVPS of nine fetuses before delivery was lower than that at the first visit. ConclusionPrenatal echocardiography has important value in the diagnosis and prognostic evaluation of prenatal FOCR. Moreover, prenatal echocardiography can dynamically observe and evaluate the changes in fetal cardiac function, which is of great significance to evaluate intrauterine fetal condition and guide delivery.