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目的对比研究胎儿心脏超声与大血管铸型,分析产前诊断胎儿心脏畸形的漏误诊原因,以提高产前诊断准确率。方法选取安贞胎儿心脏病数据库及标本库21例心脏畸形胎儿的产前影像数据及大血管铸型数据进行对比。结果大血管铸型显示,21例胎儿引产后均被证实存在复杂心脏畸形,主要诊断吻合率可达100%(21/21)。共存在46处心脏畸形,其中产前超声心动图误诊2处(4.35%,2/46,证实为动脉导管缺如1例、肝静脉回流异常1例);漏诊心脏畸形9处(19.57%,9/46,证实为动脉导管走行异常3例、动脉导管形态异常2例、上腔静脉回流异常2例、锁骨下动脉迷走2例)。结论胎儿超声心动图对血管走行异常最容易漏诊,通过铸型在产前对此类畸形提高认识有助于提高产前诊断的准确率。
OBJECTIVE: To compare the causes of misdiagnosis of prenatal diagnosis of fetal cardiac malformations with fetal heart ultrasound and macrovascular cast to improve the accuracy of prenatal diagnosis. Methods The prenatal image data of 21 fetuses with cardiac malformation fetuses from the Anzhen fetus heart disease database and the specimen database were compared with those from the large blood vessel casts. Results Large vessel cast showed that complicated cardiac malformations were confirmed in all 21 fetuses after induction of labor. The main diagnostic anastomosis rates were 100% (21/21). A total of 46 cardiac malformations were observed, including 2 misdiagnosed prenatal echocardiograms (4.35%, 2/46, 1 case of patent ductus arteriosus, 1 case of abnormal hepatic vein reflux), 9 misdiagnosed cardiac malformations (19.57% 9/46, 3 cases of abnormal ductus arteriosus, 2 cases of abnormal ductus arteriosus, 2 cases of abnormal superior vena cava reflux and 2 cases of subclavian artery vagus. Conclusions Fetal echocardiography is the most vulnerable to misdiagnosis of blood vessels. It is of great help to improve the accuracy of prenatal diagnosis through prenatal diagnosis.