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目的探讨胎儿右房增大原因的超声诊断思路。方法回顾性分析2005年1月至2014年12月中国医科大学附属盛京医院产前诊断胎儿右房增大的225例病例资料,二维超声结合彩色多普勒扫查胎儿四腔心切面、左右室流出道切面、三血管切面及三血管-气管切面等横断面,扫查腔静脉长轴切面、主动脉弓切面及动脉导管弓切面等矢状面。采用节段分析法除外胎儿先天性心脏病。结果产前超声正确诊断139例(61.8%)胎儿右房生理性增大,11例(4.9%)胎儿三尖瓣下移畸形,21例(9.3%)右房前负荷增大相关畸形,41例(18.2%)右房后负荷增大相关畸形及11例(4.9%)不明原因右房增大。2例(0.9%)产前超声诊断为生理性右房增大的胎儿出生后右房仍大。结论胎儿心脏超声检查发现心脏房室腔改变时应考虑到其他病变所引起的继发改变,分析时应以心脏血流动力学改变为主线,按照节段分析法由内脏-心房水平、心室水平以及大动脉水平逐一分析,以明确真正病因所在。
Objective To explore the causes of ultrasound diagnosis of fetal right atrium. Methods A retrospective analysis of 225 cases of prenatal diagnosis of fetal right atrium in Shengjing Hospital of China Medical University from January 2005 to December 2014 was conducted. Two-dimensional ultrasound combined with color Doppler was used to scan the fetal four-chamber heart- Left and right ventricular outflow tract section, the three-vessel section and the three-vessel-tracheal section and other cross-section, scanning the long axis of the vena cava section, the aortic arch section and the sagittal plane of the patent ductus arteriosus. Using segmental analysis except fetal congenital heart disease. Results Prenatal ultrasound correctly diagnosed 139 cases (61.8%) fetus with right atrium physiological increase, 11 cases (4.9%) fetus with tricuspid regurgitation, 21 cases (9.3%) with right anterior chamber load related deformity, 41 Cases (18.2%) related to increased right atrial load and 11 cases (4.9%) unexplained right atrial enlargement. 2 cases (0.9%) prenatal ultrasound diagnosis of physiological right atrial enlargement of the right atrium after birth is still large. Conclusion Fetal echocardiography found that changes of heart chamber should take into account the secondary changes caused by other lesions, the analysis should be the main cardiac hemodynamic changes, according to the segment analysis by the visceral - atrial and ventricular levels As well as aorta level by level analysis, in order to clarify the real cause.