摘要
目的探讨产前超声心动图诊断胎儿左心发育不良综合征(HLHS)房间隔改变及血流动力学特点。方法对29例胎儿HLHS的临床资料进行回顾性分析,并与尸检和出生后超声检查进行对比,研究其诊断要点及血流动力学变化形式。结果29例中,二尖瓣及主动脉瓣闭锁、左室重度发育不良9例;二尖瓣闭锁合并不同程度主动脉瓣狭窄及主动脉缩窄15例;二尖瓣增厚狭窄伴主动脉瓣狭窄及主动脉弓缩窄5例。29例中,见房间隔完整、增厚及卵圆孔不开放9例,多普勒超声示房间隔完整的无分流血流;余20例为房水平左向右少量分流及分流受限;25例动脉导管彩色多普勒均见反向回灌血流。结论胎儿超声心动图可早期诊断胎儿HLHS,除可检出导致左室发育不良系列左心系统病变外,房间隔提前关闭呈完整或房水平的分流受限也是评价HLHS预后及出生后手术选择的重要指征。
Objective To investigate techniques of diagnosing fetal hypoplastic left heart syndrome （HLHS） with fetal eehocardiograms（Echo）. Methods Retrospective study was undertaken in 29 cases which had been prenatally diagnosed with HLHS. A comparison was conducted between the findings and those obtained from Echo examination or autopsy, in order to study Echo diagnostic criteria, and characteristics of hemodynamic changes. Results Nine severe cases of the 29 cases with HLHS suffered aortic and mitral valve atresia, with severe left ventricular dysplasia. 15 cases suffered mitral valve atresia with various degrees of aortic stenosis and aortic arch coarctation. Five cases had thickened mitral valve with aortic stenosis and aortic arch coarctation. It was observed that intact atrial septum and thiekeness appeared in 9 cases of the 29 cases, and their foramen ovales were not open. No blood shunt was detected in intact atrial septum when Doppler ultrasound examination was used. In the other cases, few left to right shunts and shunts of limited number were present. Ductus arteriosus saw reverse flow into the blood stream. Conclusion Fetal echocardiogram may serve as a reliable means for early diagnosis of fatal HLHS. Not only would disorders of left heart resulting in left ventricular dysplasia be found, but the fact that atrial septum may be closed ahead of time to stay intact, as well as limited shunts, makes significant indications when prognosis of HLHS and surgery after birth are to be conducted.
出处
《福建医科大学学报》
2009年第1期62-64,共3页
Journal of Fujian Medical University
基金
福建省科技重点课题(2005I014)
南京军区面上课题(07M092)
