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目的探讨胎儿卵圆孔有效血流通道减小与右心房(RA)增大的相关关系,提出一种新的评价卵圆孔处血流情况的方法。方法回顾性分析于2011年1月至2017年1月在中国医科大学附属盛京医院产科超声常规检查及胎儿心脏检查中发现单纯性RA增大并怀疑卵圆孔有效血流通道减小的胎儿共32例,其中孕妇年龄19~41岁,平均年龄29.7岁;孕周29~39周,平均孕周35.6周。常规行产科超声检查除外心外畸形,于四腔心切面测量卵圆孔大小(DFO)、RA内径和左心房(LA)内径,并计算RA与LA内径比值(RA/LA),于矢状切面测量卵圆孔有效血流通道直径(DEFO)及下腔静脉右心房入口处内径(DIVC)。利用简单线性相关分析RA/LA与DEFO/DIVC和RA/LA与D_(FO)/D_(IVC)关系。描述性分析导致卵圆孔有效血流通道减小的3种情况,并统计四腔心切面与矢状切面上显示的卵圆瓣数目。结果 RA/LA与DEFO/DIVC呈负相关关系(r=-0.680 1,P<0.01),RA/LA与D_(FO)/D_(IVC)无相关关系(r=0.007 3,P=0.648 3)。卵圆孔有效血流通道减小主要分为3种情况,分别为卵圆孔减小、单瓣卵圆瓣活动度下降,以及双瓣型卵圆瓣两瓣尖构成的开口减小。四腔心切面与矢状切面显示卵圆瓣数目分别为1.31±0.47、1.50±0.51,矢状切面多于四腔心切面(t=-1.53,P=0.028)。结论胎儿卵圆孔有效血流通道减小与RA增大具有一定的相关关系。胎儿心脏超声检查发现单纯性RA增大时应注意观察有无卵圆孔有效血流通道减小,应在矢状切面上仔细扫查。
Objective To explore the relationship between the reduction of effective foramen ovale and increase of right atrium (RA) in fetal foramen and to propose a new method to evaluate the blood flow at foramen ovale. Methods From January 2011 to January 2017, we retrospectively analyzed the obstetric ultrasound and fetal heart examination of Shengjing Hospital affiliated to China Medical University from January 2011 to January 2017 and found that the fetus with simple RA increased and doubted the effective foramen ovale of the foramen ovale A total of 32 cases, of which pregnant women aged 19 to 41 years, mean age 29.7 years; gestational 29 to 39 weeks, the average gestational age 35.6 weeks. Conventional obstetrics and gynecology obstetric ultrasound except for extra-cardiac deformity, foramen ovale size (DFO), RA diameter and left atrium (LA) diameter in the four-chamber heart rate, and the ratio of RA and LA diameter (RA / LA) Foramen ovale effective blood flow channel diameter (DEFO) and inferior vena cava right atrium inlet diameter (DIVC). The relationships between RA / LA and DEFO / DIVC and RA / LA and FO / D_ (IVC) were analyzed using simple linear correlation. Descriptive analysis of the foramen ovale reduced the effective blood flow of the three cases, and statistics of the four-chamber coronal and sagittal sections showed the number of oval lobes. Results There was a negative correlation between RA / LA and DEFO / DIVC (r = -0.680 1, P <0.01), but no correlation between RA / LA and FO / D IVC (r = 0.007 3, P = 0.648 3 ). Foramen ovale effective blood flow reduction is mainly divided into three cases, respectively, reduced foramen ovale, single-valve oval valve activity decreased, and the double-valve oval valve cusp formed two openings decreased. Four-chamber coronal and sagittal sections showed that the number of oval lobes was 1.31 ± 0.47 and 1.50 ± 0.51, respectively. The sagittal section was more than the four-chamber section (t = -1.53, P = 0.028). Conclusion There is a certain correlation between the decrease of effective foramen ovale of fetus and the increase of RA. Fetal echocardiography found that simple RA increase should pay attention to observe whether the foramen ovale effective blood flow channels should be carefully scanned in the sagittal section.