胎儿超声心动图检查对冠状动脉瘘的产前超声诊断

摘要

目的探讨胎儿冠状动脉瘘的超声声像图特征，提高冠状动脉瘘的产前超声诊断水平。方法回顾性分析2005年6月至2013年12月在广东省妇幼保健院行胎儿超声心动图检查诊断的12例冠状动脉瘘超声声像图特征。结果胎儿超声心动图检查诊断存在冠状动脉瘘的胎儿共12例，其中7例胎儿出生后经超声心动图检查证实，余5例胎儿合并心内结构异常均引产，未做尸检，结果无法证实。7例证实的病例中包括左冠状动脉右房瘘1例，左冠状动脉右室瘘3例，右冠状动脉右室瘘3例，6例为单纯的冠状动脉瘘，无合并心内其他结构异常，1例左冠状动脉右室瘘合并肌部室间隔缺损。二维超声检查发现所有的病例均可显示冠状动脉，内径1.8~4.0 mm。彩色多普勒超声能清晰显示冠状动脉瘘管的大小、走行及瘘入心腔的情况。升主动脉及主动脉弓内可探及舒张期反流信号。结论当胎儿冠状动脉扩张时，联合彩色多普勒及频谱多普勒超声检查，能明确诊断冠状动脉瘘。%ObjectiveTo explore the ultrasound characteristics of coronary artery fistula to improve its prenatal diagnosis.MethodsImaging data for 12 fetuses with coronary artery fistula who underwent fetal echocardiography at our hospital from June 2005 to December 2013 were retrospectively analyzed to summarize the ultrasound characteristics of coronary artery fistula.ResultsOf the 12 fetuses, 7 were confirmed with coronary artery fistula by echocardiography after birth, and the remaining 5 were aborted due to other cardiac abnormalities (since an autopsy was not performed, the diagnosis of coronary artery fistula could not be confirmed). Of the 7 confirmed cases, 1 had left coronary artery-to-right atrium fistula, 3 had left coronary artery-to-right ventricle fistula, and 3 had right coronary artery-to-right ventricle fistula; 1 had left coronary artery-to-right ventricle fistula with muscular ventricular septal defect, and 6 had simple coronary fistula. Two-dimensional ultrasound examination revealed that coronary arteries were displayed in all cases, and the diameter ranged from 1.8 to 4.0 mm. Color Doppler ultrasound clearly showed the fistula size, course and the situation fistulas drained into heart chambers. Diastolic regurgitation signal could be detected in the ascending aorta and aortic arch.ConclusionCoronary artery fistula can be diagnosed by color Doppler ultrasound combined with spectral Doppler ultrasound when the fetal coronary artery expands.