摘要
目的 观察产前超声诊断胎儿主动脉弓离断(IAA)的价值,探讨胎儿IAA的病理演变过程。方法 回顾性分析经产前超声诊断(n=33)或引产后尸检证实(n=6)IAA的39胎胎儿超声心动图表现,并追踪其狭窄段主动脉演变情况。结果 39胎中,32胎产前超声诊断IAA,其中6胎主动脉缩窄(CoA)进行性加重,经超声心动图追踪复查诊断为IAA。其余7胎中,6胎产前超声误诊为主动脉弓病变,后均经尸检证实为IAA;1胎产前超声心动图显示左颈总动脉(LCA)与左锁骨下动脉(LSA)之间主动脉横弓无血流信号而误诊为B型IAA,经引产后尸检证实为LCA与LSA之间主动脉弓严重狭窄但未闭锁。38胎确诊IAA胎儿中,A型18胎、B型19胎、C型1胎;超声心动图表现主要为心脏四腔心切面左心室明显小于右心室或差别不明显,三血管切面主动脉明显小于肺动脉,三血管-气管切面和主动脉弓切面主动脉与降主动脉不相连,主动脉弓切面见主动脉弓弯曲度变小、走行僵直,主动脉、动脉导管及降主动脉之间无正常“V”字形结构;彩色多普勒显示主动脉弓中断处无连续血流信号,动脉导管内见血流反转。6胎最初产前超声心动图表现为CoA的IAA胎儿后经多次复查发现主动脉峡部随胎龄增大而变窄(R2=0.828~0.968),主动脉弓内径呈进行性狭窄,逐渐变为细小的条状无回声暗带,主动脉峡部血流呈前向血流-反向血流-无血流信号的变化过程,均诊断为A型IAA并经尸检证实。6胎产前超声误诊为主动脉弓疾病的IAA胎儿均见主动脉弓局部狭窄,且狭窄段见低速暗淡前向血流,后经尸检证实为3胎B型IAA、3胎A型IAA。结论 产前超声心动图可有效诊断胎儿IAA;部分胎儿IAA可由主动脉弓发育不良或CoA逐步演变而来。
Objective To observe the value of prenatal ultrasound for diagnosing fetal interruption of aortic arch(IAA),and to explore the pathological evolution of fetal IAA.Methods Data of 39 fetuses with prenatal ultrasonic diagnosed IAA(n=33)or autopsy confirmed IAA after labor induction(n=6)were retrospectively analyzed,and the narrow segments of the aorta evolution were tracked.Results Among 39 fetuses,32 were diagnosed IAA with prenatal ultrasound,6 were found with gradually aggravated coarctation of the aorta(CoA)and diagnosed IAA with follow-up echocardiography,while 6 were misdiagnosed as aortic arch dysplasia with prenatal ultrasound and then confirmed IAA with autopsy after labor induction.The rest 1 fetus was misdiagnosed as type B IAA since no blood flow signal in the transverse aortic arch between left common carotid(LCA)and left subclavian artery(LSA)on echocardiography,with severe aortic arch stenosis between LCA and LSA,but no atresia was detected with autopsy after labor induction.Among 38 fetuses with confirmed IAA,type A IAA was found in 18 fetuses,while type B and C IAA was found in 19 and 1 fetus,respectively.The echocardiographic findings of fetal IAA mainly included the left ventricle significantly smaller than or not being obvious different with the right ventricle on the four-chamber view,the aorta significantly smaller than the pulmonary artery on the three-vessel view,the aorta not connected to the descending aorta on three-vessel-tracheal view and aortic arch view,as well as smaller aortic arch curvature and walking rigidity without normal"V"shape structure among the aorta,arterial duct and descending aorta on the aortic arch view.Color Doppler present as no continuous blood flow signal at the aortic arch interruption and reversed flow within the ductus arteriosus.CoA was diagnosed with initial prenatal echocardiography in 6 fetuses with IAA,then the aortic isthmus were found narrowed along with the increase of gestational age(R 2=0.828-0.968)with repeated reexamination,and the inner diameter of the aortic arch progressively decreased and gradually became a fine strip of anechoic dark band,the blood flow of aortic isthmus presented as the process of anterior flow-reverse flow-no flow signal,finally diagnosed as type A IAA,and confirmed with autopsy.In 6 fetuses with IAA misdiagnosed as aortic arch disease with prenatal ultrasound since local stenosis of the aortic arch and low-speed forward blood flow in the stenosis section,type A and B IAA were confirmed each in 3 fetuses with autopsy,respectively.Conclusion Prenatal ultrasound could effectively diagnose fetal IAA.Fetal IAA might gradually evolve from aortic arch dysplasia or CoA in some cases.
作者
管海辰
田蕾琪
王晓芳
周启昌
杨忠诚
杨思
GUAN Haichen;TIAN Leiqi;WANG Xiaofang;ZHOU Qichang;YANG Zhongcheng;YANG Si(Medical College,Hunan University of Medicine,Huaihua 418000,China;Department of Ultrasound Diagnosis,the Second Xiangya Hospital of Central South University,Changsha 410011,China;Department of Ultrasound Diagnosis,the First Affiliated Hospital of Hunan University of Medcine,Huaihua 418000,China;Department of Ultrasound,Yueyang Central Hospital,Yueyang 414000,China)
出处
《中国医学影像技术》
CSCD
北大核心
2023年第4期564-568,共5页
Chinese Journal of Medical Imaging Technology
基金
湖南省自然科学基金面上项目(2021JJ30480)
湖南省教育厅科学研究重点项目(22A0711)。
关键词
心血管畸形
胎儿
超声检查
产前
主动脉弓离断
cardiovascular abnormalities
fetus
ultrasonography,prenatal
interruption of aortic arch
