胎儿超声心动图在先天性心脏病产前诊断中的临床价值

摘要

目的：探讨胎儿超声心动图在先天性心脏病产前诊断中的临床价值。方法回顾性分析2009年1月至2011年12月于南京大学医学院附属鼓楼医院母胎医学中心行胎儿超声心动图检查的176例可疑心脏异常胎儿的病例资料，比较系统结构筛查诊断、胎儿超声心动图诊断与产后诊断的差异。结果①176例系统结构筛查提示可疑心脏异常胎儿进行超声心动图检查，发现胎儿先天性心脏病172例，占97．7％；②176例系统结构筛查提示可疑心脏异常胎儿中，4例提示室缺可能（室缺均＜2．0 mm）的胎儿行超声心动图检查提示正常，均经产后新生儿超声心动图证实；111例终止妊娠，其中7例于本院引产并尸解，尸解结果与产前超声心动图结果均一致；61例继续妊娠，55例胎儿系统结构筛查诊断、胎儿超声心动图诊断与产后诊断均一致，1例系统结构筛查提示右心增大胎儿行超声心动图检查提示室缺、主动脉骑跨，后经产后超声心动图证实，1例系统结构筛查提示右位主动脉弓胎儿行超声心动图检查提示双主动脉弓，后经产后超声心动图证实，2例产前超声提示室缺的胎儿产后超声心动图提示正常，另误诊主动脉缩窄 1例，漏诊肺静脉异位引流 1例。结论胎儿超声心动图对先天性心脏病有较高的产前诊断率，是产前筛查胎儿先天性心脏病的重要方法。%Objective To probe the clinical value of fetal echocardiography in prenatal diagnosis of con-genital heart disease.Method 176 suspicious fetal CHD cases detected by systematical structural screen-ing in maternal-fetal medical center of Nanjing Drum Tower Hospital from January 2009 to December 2011 were included and taken fetal echocardiography,comparing the differences between systematical structural screening,fetal echocardiography and postpartum.Results ①176 suspicious fetal CHD cases detected by systematical structural screening were taken fetal echocardiography and 172 cases of fetal congenital heart diseases were found,which owns 97.7% of the whole cases.②Within the same 176 cases,fetal echocar-diography indicated normal for the 4 cases of possibly ventricular septal defect indicated by systematical structural screening (ventricular septal defect<2.0 mm),and they were verified by the postnatal neonatal echocardiography.Termination of pregnancy was found in 111 cases,7 cases of which were also autopsied in our hospital,with the result of autopsy corresponding to that of prenatal echocardiography.61 cases continued the pregnancy,where 55 cases of systematical structural screening,fetal echocardiography and postpartum were identical to each other.1 case indicated that ventricular septal defect and aortic overriding by echocardiography for the fetal with enlarged right ventricle indicated by systematical structural screen-ing,then verified by the postnatal echocardiography.1 case indicated double aortic arch by echocardio-graphy for the fetal with right aortic arch indicated by systematical structural screening,followed by the verification of postnatal echocardiography.2 cases indicates normal by postnatal echocardiography for the fetal with ventricular septal defect indicated by prenatal ultrasound.1 case was misdiagnosed coarctation of the aorta and the last case was missed anomalous pulmonary venous connection.Conclusions Fetal echo-cardiography with high prenatal detection rate of congenital heart disease is one of the important methods of prenatal screening for fetal congenital heart disease.