迷走右锁骨下动脉的产前超声诊断及临床价值

摘要

Objective To investigate the clinical value and prenatal diagnosis feasibility of fetal aberrant right subclavian artery(ARSA) with fetal echocardiography.Methods The data of 39 fetuses with ARSA were retrospectively reviewed.The prenatal and postnatal medical records,including the presence of fetal abnormalities,cardiac defect,karyotype and the outcomes of each pregnancy were collected.Results The echocardiographic feature of ARSA was that an ARSA arises as a fourth branch of the arch,from the descending aorta behind the trachea,crosses the thorax between the trachea and the spine,to reach the right arm.The overall incidence of ARSA was 2.3 ％ (39/17 280),23 cases (59.0 ％) as an isolated malformation,16 cases (41.0％) combined with cardiac defect and extracardiac abnormalities,9 cases (23.1％) with chromosomal abnormalities.23 cases underwent termination of pregnancy,2 cases died in uterus and 14 cases were born live.Isolated ARSA group had lower incidence of chromosomal abnormalities (8.7％ vs 43.8 ％,P ＜ 0.05) and higher fetal survival rate (56.5％ vs 6.2％,P ＜0.05) than the combined detects group.Conclusions The fetus with ARSA complicated with aneuploid karyotype,cardiac defects and extracardiac anomalies are at hight risk of poor prognosis.%目的 探讨产前超声对迷走右锁骨下动脉的诊断价值及临床意义.方法 回顾性分析39例产前超声诊断为迷走右锁骨下动脉的临床资料、超声图像与随访结果,研究迷走右锁骨下动脉的产前超声图像特点,观察其伴发畸形和围产期结局.结果 迷走右锁骨下动脉的超声图像特征表现为锁骨下动脉由降主动脉起始部发出并经气管及食管的后方向右侧走行.迷走右锁骨下动脉的发生率约为2.3％(39/17 280),23例(59.0％)为单纯性畸形,16例(41.0％)合并其他心内外畸形;9例(23.1％)迷走右锁骨下动脉胎儿存在染色体异常.23例终止妊娠,2例胎死宫内,14例胎儿活产.与迷走右锁骨下动脉合并心内外畸形组相比较,迷走右锁骨下动脉单发畸形组染色体异常发生率较低(8.7％对43.8％,P＜0.05),胎儿存活率较高(56.5％对6.2％,P＜0.05).结论 胎儿超声心动图对迷走右锁骨下具有重要的产前诊断价值.迷走右锁骨下动脉伴有非整倍染色体异常、心内外畸形的胎儿预后不良.