先天性心脏病合并心外畸形的产前超声诊断

摘要

Objective To investigate the value of prenatal ultrasound in diagnosis of congenital heart disease associated with extracardiac anomaly. Methods One hundred and thirty-six abnormal singleton pregnancy cases who underwent prenatal fetal systematic ultrasound and fetal cardiac ultrasound examinations were enrolled. The types of congenital heart disease associated with extracardiac anomaly and the clinical prognosis were analyzed . Results Eighty-one cases(59 . 6%) were congenital heart disease associated with one type of extracardiac anomaly , 33 cases(24 . 3%) associated with two types of extracardiac anomaly , 15 cases(11 . 0%) associated with 3 types of extracardiac anomaly , 7 cases associated with 4 types of extracardiac anomaly(5.1%). 53.7%of the cases were complex congenital heart disease associated with extracardiac anomaly. The most common independent occurrence of congenital heart disease was ventricular septal defect(33 . 8%). Eight cases of them underwent chromosome examination , 2 cases had chromosomal abnormalities(trisomy-18 syndrome). All of the cases were followed up,labor induction was performed on 116 cases. Three cases were diagnosed as ventricular septal defect in the fetal stage, but postnatal examinations showed normal. One case was misdiagnosed as atrial septal defect in prenatal stage, 3 cases were diagnosed as uronephrosis but postnatal reexamination shown there was no abnormality, 13 cases were reexamined by ultrasound and the results were in conform with examinations conducted in fetal period,among them surgical treatment was performed in 7 cases. Conclusion Congenital heart disease associated with extracardiac anomaly can be effectively screened by prenatal ultrasound,it can provide valuable experience for improving prenatal and postnatal care.%目的：探讨超声检查在胎儿先天性心脏病合并心外畸形诊断中的价值。方法收集我院同时行产前系统超声和胎儿心脏超声检查，且超声诊断均有异常的单胎妊娠病例136例，分析胎儿先天性心脏病合并心外畸形的类型及临床预后。结果136例先天性心脏病合并心外畸形的病例中，81例（59．6％）合并一种心外畸形，33例（24．3％）合并两种心外畸形，15例（11．0％）合并三种心外畸形，7例（5．1％）合并四种心外畸形。复合型先天性心脏病合并心外畸形占53．7％。最常见的独立发生的先天性心脏病为室间隔缺损，占33．8％。其中，8例同时行染色体检查，2例染色体异常，均为18－三体综合征。对所有病例追踪随访，116例行引产术；20例继续妊娠，其中3例产前超声诊断的室间隔肌部小缺损出生后检查为正常；1例产前误诊房间隔缺损；3例产前超声诊断的肾积水出生后复查正常；13例出生后复查超声与产前超声诊断一致，其中7例行手术治疗。结论超声检查能有效筛查胎儿先天性心脏病及其合并的心外系统畸形，为优生优育提供价值。