摘要
目的探讨胎儿超声心动图在监测妊娠中晚期卵圆孔血流受限(restrictive foramen ovale,RFO)中的临床应用价值。方法回顾性分析7319例经产前超声心动图检查胎儿中诊断为RFO且不合并心脏畸形胎儿的检出率、超声影像特征,并随访妊娠结局及出生儿预后。结果7319胎儿中单纯RFO40例,阳性检出率为0.55%。所有病例均呈现房间隔右向左<2.5mm的细窄分流、右房增大、右心室与左心室比值以及肺动脉与主动脉比值增大的超声影像特征;卵圆孔瓣开放受限(70%)、卵圆孔径<2.5mm(30%)为RFO的直接二维超声表现;房间隔膨出瘤(62.5%)、卵圆孔瓣冗长(57.5%)、动脉导管改变(57.5%)为RFO常见的超声影像表现。随着孕周增加,RFO胎儿的右房与左房横径比、右室与左室横径比、肺动脉与主动脉内径比的增长差异有统计学意义(P=0.004,P<0.001,P<0.001)。40例单纯RFO胎儿中,21例足月分娩,8例提前剖宫产分娩(产前超声提示三尖瓣重度反流),5例引产,6例失访。出生的29例新生儿中,1例死于心功能衰竭,其余28例产后4月复查时心脏结构及功能恢复正常。结论RFO具有以房间隔右向左细窄分流为主的特征性超声影像表现,超声心动图可监测以右心负荷增加及左心容量不足为基础的胎儿心脏结构及功能改变,对评估胎儿宫内状况及指导分娩具有重要临床意义。
Objective To investigate the clinical significance of restrictive foramen ovale (RFO) monitored by fetal echocardiography during the middle to late stage of pregnancy. Methods The detection rate,echocardiographic features and outcome in fetuses with RFO without cardiac malformations from 7 319 pregnant women received prenatal echocardiography were retrospectively reviewed and analyzed. Results RFO was found in 40 of 7 319 (0.55%) fetuses.The inclusion criteria including a narrow right to left shunt of less than 2.5 mm in diameter across atrial septum,enlarged right atrium,increased right-to-left ventricular size ratio,and increased size ratio of main pulmonary artery to aorta were present in 40 fetuses.The direct ultrasound characters of RFO included limited opening of oval valve (70%) and foramen ovale diameter less than 2.5 mm (30%).And atrial septal aneurysm (62.5%),redundant primum atrial septum (57.5%),abnormal ductus arteriosus (57.5%) might also be present commonly in RFO.As the gestational weeks increased,the size ratio of right-to-left atrium,right-to-left ventricle and the main pulmonary artery to aorta also increased significantly(P=0.004,P<0.001,P<0.001).Among the 40 fetuses with RFO,21 cases (52.5%) gave birth in full term,8 cases (20%) which were detected severe tricuspid regurgitation gave birth in early cesarean section,5 cases (12.5%) had induced labor and 6 cases (15%) were lost in the follow-up.Of the 29 newborns,only 1 case died of heart failure,and the other 28 subjects recovered both from heart structure or cardiac function within four months. Conclusions RFO without cardiac malformations presents echocardiographic features characterized by a narrow right to left shunt of less than 2.5 mm in diameter across atrial septum.Fetal echocardiography can monitor the dynamic change of fetal heart structure and function based on the increase of right heart load and decrease of left heart volume,which has important clinical significance for assessing fetal intrauterine condition and prognosis.
作者
李泞珊
夏红梅
邓曦
蒋欢
唐琪
高云华
刘政
Li Ningshan;Xia Hongmei;Deng Xi;Jiang Huan;Tang Qi;Gao Yunhua;Liu Zheng(Department of Ultrasound,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2019年第1期36-41,共6页
Chinese Journal of Ultrasonography
基金
重庆市社会事业与民生保障科技创新专项重点研发项目(cstc2017shms-zdyfX0017)
第三军医大学临床研究项目(2015YLC10).
作者简介
通信作者:夏红梅,Email:xiahm98506@126.com.
