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目的评价超声心动图检测胎儿右优势心(RDH)的临床意义,描述各类RDH胎儿的超声心动图特点。方法回顾性地总结和分析40例RDH胎儿的声像图特点。RDH胎儿的诊断标准:产前超声心动图检测胎儿右、左心房和心室的内径比及肺动脉与主动脉直径比>1.5;产前超声心动图排除胎儿先天性心脏病(CHD)(尤其CoA)和心外畸形。结果 (1)40例RDH胎儿。产后超声心动图或临床随访证实15例(37.5%)为正常胎儿,9例(22.5%)为RDH伴IUGR和动脉导管瘤,16例(40%)为RDH伴发CHD;RDH伴发的CHD包括主动脉缩窄6例,肺静脉异位引流3例,静脉窦型房间隔缺损、室间隔缺损、永存左上腔静脉伴冠状窦扩张各2例、主动脉弓离断1例。(2)RDH伴发CHD的胎儿其RDH发生的时间要早于RDH伴发IUGR、动脉导管瘤或正常RDH胎儿(P<0.05或0.001)。RDH伴发CHD胎儿其三尖瓣反流发生率、RA/LA、RV/LV、PA/AO明显高于RDH伴IUGR、动脉导管瘤或正常RDH胎儿(P<0.05或0.001)。(3)RDH伴CHD胎儿随妊娠时间增加,其RDH逐渐加重(P<0.05或0.005)。结论 (1)RDH胎儿产后常伴发CHD,尤其CoA,产后应加强随访观察;(2)RDH伴CHD胎儿有一定的超声心动图特点,可以与RDH伴IUGR、动脉导管瘤及正常RDH胎儿相鉴别。
Objective To evaluate the clinical significance of echocardiography in detecting fetal right dominant heart (RDH) and to describe the echocardiographic features of various RDH fetuses. Methods Retrospectively summarized and analyzed 40 cases of RDH fetus sonographic features. RDH fetus diagnostic criteria: prenatal echocardiography fetal right and left atrium and ventricular diameter ratio and pulmonary artery to aortic diameter ratio> 1.5; prenatal echocardiography to exclude fetal congenital heart disease (CHD) (especially CoA) And extra-cardiac malformations. Results (1) 40 cases of RDH fetus. Postnatal echocardiography or clinical follow-up confirmed that 15 (37.5%) were normal fetuses, 9 (22.5%) were RDH with IUGR and arterioles, and 16 (40%) were RDH with CHD; RDH with CHD Including aortic constriction in 6 cases, anomalous pulmonary venous drainage in 3 cases, sinus atrial septal defect, ventricular septal defect, permanent left superior vena cava with coronary sinus dilatation in 2 cases, aortic arch off in 1 case. (2) The RDH of RDH-associated CHD was earlier than RDH-associated IUGR, TA, or normal RDH fetuses (P <0.05 or 0.001). The incidence of tricuspid regurgitation in RDH with CHD fetuses was significantly higher than that of RDH with IUGR, arterioles, or normal RDH fetuses (P <0.05 or 0.001), RA / LA, RV / LV and PA / AO. (3) RDH with CHD fetus increased with pregnancy, the RDH gradually increased (P <0.05 or 0.005). Conclusion (1) RDH fetus often accompanied by postpartum CHD, especially CoA, postpartum should be strengthened follow-up observation; (2) RDH with CHD fetus have some characteristics of echocardiography, and RDH with IUGR, arterioles and normal RDH fetal phase Identification.