Diagnostic value of fetal echocardiography for obstructive heart malformations of the right ventricular system with low lung blood
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摘要:
目的探讨胎儿超声心动图对肺血少之右心系统阻塞性心脏畸形的诊断价值。 方法回顾2017年3月~2020年3月本院孕20~28周有高危倾向或自愿要求行胎儿超声心动图检查的1036例孕妇，获取并分析胎儿心脏位置、各节段图像及合并畸形情况，相关统计学资料分析超声心动图检查准确度。 结果1036例孕妇中检出右位心胎儿86例，86例右位心中镜像心39例（45.35%）、右旋心37例（43.02%）、右房异构4例（4.65%）、左房异构6例（6.98%）。超声心动图对心脏各节段、心室与大动脉连接有诊断意义（P < 0.05），与心血管造影诊断一致性强（Kappa > 0.5）。右旋心和右镜心存在肺动脉狭窄或闭锁者相比，差异有统计学意义（P < 0.05）；超声心动图对心脏合并畸形诊断的敏感度95.00%（76/80）、特异性83.33%（5/6）、准确性94.19%（81/86），超声心动图与心血管造影一致性强（Kappa=0.503）。 结论右心系统阻塞性心脏畸形各节段均可出现异常，多合并复杂的肺血少异常情况，超声心动图更直观、全面观察心脏解剖学及血流动力学变化，对判断合并肺血少的复杂畸形具有较高诊断价值。 Abstract:ObjectiveTo investigate the diagnostic value of fetal echocardiography for obstructive heart malformations of the right ventricular system with low lung blood. MethodsFrom March 2017 to March 2020, 1036 pregnant women who had a high-risk tendency or voluntarily requested fetal echocardiography during their pregnancy period of 20 to 28 weeks in our hospital were reviewed. The position of the fetal heart, the images of each segment and the combined malformations were obtained and analyzed, and the accuracy of echocardiography with relevant statistical data were analyzed. ResultsThere were 86 cases of dextrocardia fetus, 39 cases of dextrocardia mirror images (45.35%), 37 cases of dextrorotation heart (43.02%), 4 cases of right atrial heterogeneity (4.65%), and 6 cases of left atrial heterogeneity (6.98%) detected in 1036 pregnant women. Echocardiography had diagnostic significance for the connection of various segments of the heart, ventricle and aorta (P < 0.05), and it was consistent with the diagnosis of cardiovascular angiography (Kappa > 0.5). Compared with those with pulmonary artery stenosis or atresia in dextrorotation heart and right-sided heart, the difference was significant (P < 0.05). The sensitivity of echocardiography to the diagnosis of cardiac malformations was 95.00% (76/80), specificity was 83.33% (5/6), accuracy was 94.19% (81/86), and the consistency between echocardiography and cardiovascular angiography was strong (Kappa=0.503). ConclusionEach segment of right heart system obstructive cardiac malformation can be abnormal, and most of them are complicated with abnormal pulmonary blood deficiency. Echocardiography is more intuitive and comprehensive to observe the changes of cardiac anatomy and hemodynamics, which has high diagnostic value in judging the complicated malformation with pulmonary blood deficiency. -
图 3 右室流出道切面示右室流出道频谱流速减低
Figure 3. View of right ventricular outflow tract: decreased spectral velocity of right ventricular outflow tract.
表 1 86例右位心患者心脏节段分析
Table 1. Segment analysis of 86 patients with dextrocardia[n(%)]
节段分析 镜像心（n=39） 右旋心（n=37） 右房异构（n=4） 左房异构（n=6） 超声心动图 心血管造影 超声心动图 心血管造影 超声心动图 心血管造影 超声心动图 心血管造影 房室连接 相适应 32(82.50) 32(82.50) 15(40.54) 15(40.54) 1(25.00) 2(50.00) 2(33.33) - 不相适应 2(5.13) 2(5.13) 12(32.43) 12(32.43) - - 1(16.67) 1(16.67) 心室双入口 4(10.26) 4(10.26) 10(27.03) 10(27.03) 3(75.00) 2(50.00) 3(50.00) 5(83.33) 房室无连接 1(2.56) 1(2.56) - - - - - - 房室连接方式 双开通房室瓣 36(92.31) 36(92.31) 30(81.08) 30(81.08) - - 1(16.67) 2(33.33) 共同房室瓣 2(5.13) 2(5.13) 5(13.51) 5(13.51) 3(75.00) 3(75.00) 5(83.33) 4(66.67) 单个房室瓣 1(2.56) 1(2.56) 2(5.41) 2(5.41) 1(25.00) 1(25.00) - - 心室形态 双室心 33(84.62) 33(84.62) 28(75.68) 28(75.68) 1(25.00) 1(25.00) 4(66.67) 5(83.33) 单室心 6(15.38) 6(15.38) 9(24.32) 9(24.32) 3(75.00) 3(75.00) 2(33.33) 1(16.67) 心室动脉连接类型 相适应 25(64.10) 24(61.54) 9(24.32) 7(18.92) 1(25.00) - 1(16.67) 1(16.67) 不相适应 3(7.69) 4(10.26) 10(27.03) 9(24.32) - - - - 右室双出口 6(15.38) 7(17.95) 9(24.32) 12(32.43) - - 2(33.33) 4(66.67) 不定心室双出口 3(7.69) 3(7.69) 6(16.22) 7(18.92) 3(75.00) 4(100.00) 2(33.33) 1(16.67) 心室单出口 2(5.13) 1(2.56) 3(8.11) 2(5.41) - - - - 
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2 超声心动图诊断心脏节段的诊断效能
2. Diagnostic efficiency of echocardiography in the diagnosis of cardiac segments
项目 AUC 敏感度（%） 特异性（%） 95%CI P 房室连接 0.889 92.29 81.16 0.820~0.944 < 0.001 房室连接方式 0.920 95.04 84.77 0.841~0.965 < 0.001 心室形态 0.665 82.20 91.20 0.538~0.821 0.022 心室动脉连接类型 0.671 86.52 94.88 0.550~0.837 0.018
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[1] Evangelista M, Barletta M, Corciu A, et al. The additional value of three-dimensional transesophageal echocardiography in the diagnosis of unusual complication of bioprosthetic mitral valve[J]. J Cardiovasc Echography, 2019, 29(2): 78. doi: 10.4103/jcecho.jcecho_75_18 [2] 商建峰, 贺晨宇, 陈东, 等. 胎儿心房异构及其合并心内外畸形的病理学分析[J]. 心肺血管病杂志, 2018, 37(1): 1-4. doi: 10.3969/j.issn.1007-5062.2018.01.001 [3] 郭勇, 刘晓伟, 张烨, 等. 三维超声体积自动测量技术评估肺血减少型先天性心脏病胎儿肺体积变化[J]. 中国医学影像技术, 2019, 35 (1): 100-3. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201901034.htm [4] 王媛, 赵旭, 杨娅, 等. 超声时间-空间关联成像技术及三维超声在胎儿先天性心脏畸形及心外畸形诊断中的应用价值[J]. 中国全科医学, 2019, 22(3): 346-50. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201903028.htm [5] 唐中才. 超声心动图技术在胎儿心脏结构与血流动力学评估中的应用及临床价值[J]. 山西医药杂志, 2019, 48(24): 3035-7. doi: 10.3969/j.issn.0253-9926.2019.24.008 [6] 徐霞, 贺秀红, 刘晓燕, 等. 胎儿法洛四联症的产前超声诊断价值及体会[J]. 实用医学影像杂志, 2020, 21(1): 92-3. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXY202001050.htm [7] 贾赛玉, 王跃涛, 王冬艳, 等. 超声三步法快速筛查胎儿先天性心脏畸形的临床价值[J]. 江苏医药, 2018, 44(2): 162-5, 120. https://www.cnki.com.cn/Article/CJFDTOTAL-YIYA201802011.htm [8] 莫莉, 郑春华, 包敏, 等. 超声心动图诊断右肺动脉异常起源于主动脉的价值[J]. 中国超声医学杂志, 2019, 35(9): 860-2. doi: 10.3969/j.issn.1002-0101.2019.09.028 [9] Khan HS, Javed A, Mohsin M, et al. Elevated D-dimers and right ventricular dysfunction on echocardiography for diagnosis of pulmonary embolism: a validation study[J]. Cureus, 2020, 12(10): e10778. http://www.researchgate.net/publication/344460876_Elevated_D-Dimers_and_Right_Ventricular_Dysfunction_on_Echocardiography_for_Diagnosis_of_Pulmonary_Embolism_A_Validation_Study [10] Chitra N, Vijayalakshmi IB. Fetal echocardiography for early detection of congenital heart diseases[J]. J Echocardiogr, 2017, 15 (1): 13-7. doi: 10.1007/s12574-016-0308-2 [11] 孙芸, 陆士奇, 屠苏, 等. 血液标志物和心脏彩超检查在慢性阻塞性肺疾病急性加重期相关性肺动脉高压的评估价值[J]. 中国急救医学, 2019, 39(11): 1058-64. doi: 10.3969/j.issn.1002-1949.2019.11.010 [12] Richards B, Freel L, Stiver C, et al. Serial fetal echocardiograms in hypoplastic left heart syndrome fetuses: Does it affect immediate post-natal care?[J]. Int J Cardiol, 2020, 301: 80-4. doi: 10.1016/j.ijcard.2019.11.119 [13] 黄蓓蕾, 骆迎春. 胎儿右位心的产前超声诊断[J]. 中国超声医学杂志, 2019, 35(4): 354-7. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY201904025.htm [14] 张俊, 邓学东, 潘琦, 等. 早孕期超声心动图在胎儿严重先心病中的应用[J]. 中国临床医学影像杂志, 2019, 30(1): 28-31. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX201901011.htm [15] 石婉明, 丁文虹, 杨静, 等. 左房异构及其合并畸形的超声心动图诊断与治疗转归分析[J]. 中华医学超声杂志: 电子版, 2019, 16(8): 609-14. doi: 10.3877/cma.j.issn.1672-6448.2019.08.011 [16] 刘吉庆, 苏静, 孟秋霞. 四维超声心动图联合二维彩超在胎儿先天性心脏畸形筛查中的应用[J]. 中国妇幼保健, 2019, 34(19): 4574-6. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201919071.htm [17] 王小漫. 超声心动图在胎儿肺动脉及左、右肺动脉分支异常中的诊断价值[J]. 中国医疗设备, 2019, 34(7): 76-9, 86. doi: 10.3969/j.issn.1674-1633.2019.07.018 [18] 张婷婷, 徐楠, 李慕子, 等. 超声心动图对主动脉瓣闭锁的诊断价值[J]. 中国超声医学杂志, 2019, 3(12): 1137-9. doi: 10.3969/j.issn.1002-0101.2019.12.027 [19] 黄晓英. 产前心脏超声筛查在胎儿心脏畸形诊断中的价值分析[J]. 当代医学, 2019, 25(23): 110-2. doi: 10.3969/j.issn.1009-4393.2019.23.047 [20] 徐鹏, 李军, 杨文娟, 等. 胎儿右心系统扩大的类型及超声诊断思路[J]. 中华医学超声杂志: 电子版, 2019, 16(6): 433-7. doi: 10.3877/cma.j.issn.1672-6448.2019.06.005 [21] 李兰, 谢海蓉, 饶静, 等. 超声心动图在妊娠中晚期胎儿复杂性先天性心脏畸形筛查中的作用[J]. 中国医药导报, 2019, 16(1): 138-40, 144. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201901035.htm [22] 周成双, 张玉奇, 朱善良, 等. 完全性肺静脉连接异常的产前超声心动图诊断价值及漏误诊分析[J]. 中国医学影像学杂志, 2017, 25(7): 520-4. doi: 10.3969/j.issn.1005-5185.2017.07.011 [23] 李慧东, 田志云, 张志坤. 高危妊娠中孕11~16周应用超声筛查胎儿心脏畸形的价值[J]. 国际妇产科学杂志, 2018, 45(5): 556-9, 570. doi: 10.3969/j.issn.1674-1870.2018.05.017 [24] 王园园, 王锟, 董凤群, 等. 产前超声诊断胎儿心血管畸形的价值分析[J]. 中国临床医学影像杂志, 2019, 30(1): 24-7. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX201901010.htm [25] 战鸿雁, 尹虹, 陶国伟, 等. 多普勒超声心动图对中晚孕胎儿肺动脉收缩压异常增高的随访观察[J]. 中华超声影像学杂志, 2018, 27(9): 771-6. doi: 10.3760/cma.j.issn.1004-4477.2018.09.008 [26] 黄丹萍, 李秦莉, 刘金蓉, 等. 胎儿超声心动图在肺动脉分支异常的产前诊断价值[J]. 中国妇幼健康研究, 2020, 31(9): 1235-42. doi: 10.3969/j.issn.1673-5293.2020.09.021 [27] 陈爱灼, 陈金清. 超声心动图在三房心合并主动脉瓣二叶诊治中的应用[J]. 分子影像学杂志, 2019, 42(4): 480-1. doi: 10.12122/j.issn.1674-4500.2019.04.14 -
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