胎儿心脏血流动力学特征及其形态rn结构的超声心动图检测

摘要

Purpose To evaluate and describe fetal cardiac development and hemodynamics high risk rnpregnancy by using ultrasound technique. Methods Two-hundred and thirty-three pregnancies were rnprospectively studied by using the detailed fetal echocardiographic procedure( fetus gestational age from 19 rnweeks to 39 weeks). Cardiac chamber size, internal diameter of great arteries were documented together with rnthe presence of inflow and outflow wave patterns. In utero diagnoses of variety of congenital heart defects rnwere also conducted. Results Cardiac chamber size and internal diameter of great arteries showed a rnpositive correlation with the increasing of gestational age. Left and right ventricles were demonstrated the rnsame size during whole fetal observational period. Blood flow through mitral valve and tricuspid valve were rntypically 'M' type. By comparing 'e' wave and 'a' wave, this inflow blood velocity pattern was dominant rnby 'a' wave, though the ratio of a/e gradually decreased during the fetal development period. Blood velocity rnin aorta and pulmonary artery remained steady along with the gestational age. The detection rate of verity rntypes of congenital heart diseases in this sample population was 5.7% (13 cases) ,the major problem was the rncomplex heart malformation. The occurrence of fetal cardiac arrhythmia was 14 cases (16 % ), with the rnmajority of atrial premature beat. Conclusions Fetal echocardiography can be used to evaluate and rnmonitor the change of cardiac anatomy, structure and hemodymanics during the different gestational age.rnThis has provided a new approach to the further understanding of fetal cardiac development, and is importantto the screening of congenital heart disease during pregnancy.%目的运用超声心动图技术对中国高危孕妇的胎儿心脏结构、血流动力学的时相性变化特征进行探rn测，了解其在胚胎心脏发育中动态变化的规律；对选择性样本的胎儿先天性心脏畸形及其他心脏异常的检出率rn进行描述性研究。方法 1998～1999年间，对233例胎龄19～39周的胎儿，运用前瞻性研究设计，采用国际标rn准的详细化超声心动图方法对胎儿的心脏结构和血流动力学特征进行了系统探测。结果满意获取了各胎龄rn期心房、心室、主动脉、肺动脉的内径参数，左、右心室内径基本相同，各类参数与胎龄显示高度的正相关关系。rn整个胎儿阶段二尖瓣、三尖瓣血流模式中a峰始终占主导地位，a、e峰的比例随胎龄增长呈现缓慢下降趋势。主rn动脉、肺动脉口流速在不同胎龄期的变化无显著意义。超声诊断疑有先天性心脏畸形胎儿的病理检查或生后检rn查显示，本组人群先天性心脏病检出率为13例(5.7％)，以复杂畸形为多数。同时发现14例有心律紊乱占6％，rn房性早搏占多数。结论胎儿超声心动图可用以非创伤性的探测胎儿各期的心腔和大血管的内径，以及血流动rn力学的特征，这不仅对了解不同胎儿时期心脏正常的解剖和生理发育特征有直接的实践意义，而且对胎儿先天rn性心脏病的筛查和诊断提供了有效的手段。