胎兒超聲心動圖在診斷法洛四聯癥中的價值

石琳　聶志偉　張軍連

【摘要】 目的：探討超聲心動圖在診斷胎兒法洛四聯癥中的價值及診斷技巧，提高此畸形的產前檢出率。方法：對15例經引產病理檢查或者產后超聲心動圖確診為法洛四聯癥的胎兒超聲心動圖進行回顧性的分析，總結各掃查切面（四腔心切面、左右室流出道切面、三血管切面、主肺動脈長軸切面、主動脈弓切面、心底短軸切面）的聲像圖特征及診斷價值。結果：15例中胎兒超聲心動圖診斷正確13例，占比86.67%，誤診右室雙出口1例，漏診1例。法洛四聯癥胎兒超聲心動圖聲像圖基本特征：室間隔缺損15例，主動脈騎跨14例，肺動脈不同程度的狹窄12例或閉鎖1例。右室前壁增厚不明顯0例，右室流出道及肺動脈血流速度增快不明顯，僅有4例超過1.0 m/s。合并心內畸形（右位主動脈弓）2例，合并其他系統畸形4例。結論：胎兒超聲心動圖檢查對胎兒TOF具有明確的診斷價值，為改善預后和進行及時有效的干預提供了可靠的臨床依據。

【關鍵詞】 胎兒； 超聲心動圖； 法洛四聯癥

【Abstract】 Objective：To explore the value of echocardiography and diagnostic techniques in the diagnosis of fetal tetralogy of Fallot in，improve the detection rate of this deformity in prenatal.Method：15 cases confirmed by pathological examination or induction of postpartum echocardiography for fetal tetralogy of Fallot echocardiography were retrospectively analyzed，summarized the sections（four chamber view，left ventricular outflow tract view and three vessels view and main pulmonary artery long axis view，aortic arch section and basal short axis view）the sonographic characteristics and diagnostic value.Result：15 cases of fetal echocardiography in the correct diagnosis of 13 cases，accounting for 86.67%，1 case was diagnosed as double outlet right ventricle，1 case of misdiagnosis.Tetralogy of Fallot fetal echocardiography basic feature map sonogram：15 cases of ventricular septal defect，aorta in 14 cases，12 cases of pulmonary artery stenosis or 1 case of atresia.Right ventricular anterior wall thickening not obvious.Right ventricular outflow tract and pulmonary artery blood flow velocity increase not obvious，there were 4 cases of more than 1.0 m/s.Combined cardiac malformation（right aortic arch） in 2 cases，4 cases with other system abnormalities.Conclusion：Fetal echocardiography has definite diagnostic value for fetal TOF，which provides a reliable clinical basis for the improvement of prognosis and timely and effective intervention.

【Key words】 Fetus； Ultrasonic echocardiography； Tetralogy of Fallot

Fist-authors address：Zhenjiang Maternal and Child Health Hospital，Zhenjiang 212001，China

doi：10.3969/j.issn.1674-4985.2017.25.025

法洛四聯癥（Tetralogy of Falllot，TOF）又稱先天性紫紺四聯癥，占整個先天性心臟病的8%～10%，占胎兒先天性心臟病的3%，是最常見的紫紺型先天性心臟病[1]。產前篩查能夠早期發現胎兒畸形，包括實驗室檢查和影像學檢查，其中超聲的應用范圍最廣，方法成熟，效果可靠，經濟且無損傷[2]。不采取外科治療的TOF患兒，死亡率較高，雖然外科技術已相當成熟，但對于一些重型TOF以及合并其他系統畸形的TOF患兒的遠期療效仍然欠佳。因此，孕期明確診斷可進行準確的產前咨詢及圍生期處理，對改善TOF患兒的預后及提高生育質量具有十分重要的臨床意義[3-4]?！?br>