超声心动图在诊断胎儿心内膜垫缺损的临床应用价值(1)
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[摘要] 目的 探讨超声心动图产前诊断胎儿心内膜垫缺损的临床应用价值。 方法 回顾性分析产前超声心动图诊断19例胎儿心内膜垫缺损的超声心动图的图像特征，并追踪结果。 结果 16例胎儿心内膜垫缺损的经上级医院超声心动图及尸解或经产后超声心动图证实，3例失访。16例产前超声心动图诊断胎儿心内膜垫缺损中，完全型心内膜垫缺损11例，不完全型心内膜垫缺损4例，1例为大的房间隔缺损。15例胎儿心内膜垫缺损中，7例为单纯的心内膜垫缺损，2例为合并心包积液，3例为合并胸水、腹水，2例为合并大动脉转位，1例为合并肺动脉狭窄。 结论 超声心动图产前诊断胎儿心内膜垫缺损准确率高，具有较好的临床应用价值。
[关键词] 胎儿；心内膜垫缺损；超声心动图；产前诊断
[中图分类号] R445.1 [文献标识码] B [文章编号] 1673-7210(2012)01(c)-0168-02
Diagnostic value of prenatal echocardiography in detecting fetal endocardial cushion defect
WANG Shuyun TONG Yajun KANG Honhxia YIN Shuhong LI Juan
Department of Ultrasound, Maternity and Child Health Hospital of Daxing Distrit, Beijing 102600, China
[Abstract] Objective To explore the clinical diagnostic value of echocardiography in detecting fetal endocardial cushion defect. Methods Sonographs from 19 cases with fetal endocardial cushion defects were recorded during routine fetal echocardiography. Results 16 cases fetal endocardial cushion defect were confirmed including 11 cases complete type and 4 cases incomplete type endocardial cushion defect by postnatal echocardiography or autopsy, 1 case larger atrial septal defect, and 3 cases was lost. In the 15 endocardial cushion defect cases, 7 cases were diagnosed as single endocardial cushion defect, 2 cases were with pericardial effusion, 3 cases were with pleural effusion and ascites, 2 cases with transposition of great arteries and 1case with pulmonary stenosis. Conclusion Fetal echocardiography is the leading diagnostic tool for prenatal evaluation of fetal endocardial cushion defect.
[Key words] Fetal; Endocardial cushion defect; Echocardiography; Prenatal diagnosis.
心内膜垫缺损(endocardial cushion defects)是一种心脏间隔缺损，又称房室间隔缺损，范围广，累及房间隔、室间隔及房室瓣膜。其发生率约占先天性心脏畸形的7%，出生婴儿中发生率约1/3 000[1]。心内膜垫缺损的自然病程预后很差，完全型心内膜垫缺损患儿80%在2岁内死亡[2]，该畸形已被中华医学会超声指南列为在孕18~24周中必须明确诊断的胎儿致命性心脏畸形，在超声检查中具有重要意义[3]。本文回顾性总结分析了自2007年以来我院超声心动图诊断的19例胎儿心内膜垫缺损的诊断体会及声像图特征，探讨超声心动图产前诊断胎儿心内膜垫缺损的临床应用价值。
1 资料与方法
1.1 一般资料
选取2007年8月~2011年8月在我院做产前畸形筛查的孕妇，经胎儿超声心动图诊断为心内膜垫缺损的病例19例，孕妇妊娠20~33周，平均(27.2±1.1)周；孕妇年龄17~43岁，平均年龄(28.8±0.6)岁。均为中晚期妊娠，均为系统筛查畸形或2次来我院侧重筛查心脏畸形的孕妇。
1.2 仪器与方法
1.2.1 仪器 采用Acuson Seqiua512型彩色多普超声诊断仪，探头频率3.5~5.0 MHz。选用胎儿超声心动图条件。
1.2.2方法 孕妇取平卧位，胎儿体位不佳时，嘱孕妇左右侧卧变换体位，检查仍不理想者在诊室外活动20~30 min自觉胎儿在腹中有明显的胎动再重复检查 ......
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