CAJ | 학술논문

目的探讨胎儿主动脉弓异常的超声诊断方法技巧、诊断线索,提高主动脉弓异常的产前超声诊断率.方法选择2006年1月至2009年12月在我院行产前系统超声检查并获得结果验证的1472例正常和异常胎儿为研究对象,每个胎儿均进行四腔心切面、左右心室流出道切面、三血管气管切面的观察,当怀疑主动脉弓异常时,进一步获得主动脉弓长轴切面和冠状切面及经过气管的冠状切面.结果产前超声共诊断148例主动脉弓异常,漏诊1例,92例获得结果验证,包括主动脉弓缩窄28例,主动脉弓离断10例,右位主动脉弓及主动脉弓分支异常52例,双主动脉弓2例.24例合并其他严重心脏畸形.主动脉弓缩窄、主动脉弓离断的线索为三血管气管平面均显示主动脉弓内径和动脉导管内径比例失调,主动脉弓内径异常小,四腔心切面显示左心小,左右心不对称;右位主动脉弓及其分支异常在3VTV平面显示主动脉弓位于气管右侧、主动脉弓和动脉导管之间距离增大呈"U"形和(或)在气管后方有发自降主动脉起始段的血管分支-锁骨下动脉.主动脉弓横切面即三血管气管切面、纵切面、冠状切面的显示率分别为 98.4%、90.0%、81.9%.结论四腔心切面显示左心小,左右心不对称和3VT平面显示主动脉弓内径异常小,主动脉弓与动脉导管内径比例失调是诊断主动脉弓缩窄、离断的线索,主动脉弓和动脉导管之间距离增大是诊断右位主动脉弓的线索,三血管气管平面是诊断主动脉弓异常最易显示和最敏感的切面,主动脉弓冠状切面、纵切面及经过气管的冠状切面对诊断具有补充和鉴别意义.
목적 탐토태인주동맥궁이상적초성진단방법기교、진단선색,제고주동맥궁이상적산전초성진단솔.방법 선택2006년1월지2009년12월재아원행산전계통초성검사병획득결과험증적1472례정상화이상태인위연구대상,매개태인균진행사강심절면、좌우심실류출도절면、삼혈관기관절면적관찰,당부의주동맥궁이상시,진일보획득주동맥궁장축절면화관상절면급경과기관적관상절면.결과 산전초성공진단148례주동맥궁이상,루진1례,92례획득결과험증,포괄주동맥궁축착28례,주동맥궁리단10례,우위주동맥궁급주동맥궁분지이상52례,쌍주동맥궁2례.24례합병기타엄중심장기형.주동맥궁축착、주동맥궁리단적선색위삼혈관기관평면균현시주동맥궁내경화동맥도관내경비례실조,주동맥궁내경이상소,사강심절면현시좌심소,좌우심불대칭;우위주동맥궁급기분지이상재3VTV평면현시주동맥궁위우기관우측、주동맥궁화동맥도관지간거리증대정"U"형화(혹)재기관후방유발자강주동맥기시단적혈관분지-쇄골하동맥.주동맥궁횡절면즉삼혈관기관절면、종절면、관상절면적현시솔분별위 98.4%、90.0%、81.9%.결론 사강심절면현시좌심소,좌우심불대칭화3VT평면현시주동맥궁내경이상소,주동맥궁여동맥도관내경비례실조시진단주동맥궁축착、리단적선색,주동맥궁화동맥도관지간거리증대시진단우위주동맥궁적선색,삼혈관기관평면시진단주동맥궁이상최역현시화최민감적절면,주동맥궁관상절면、종절면급경과기관적관상절면대진단구유보충화감별의의.
Objective To study the ultrasonographic clues and methods for fetal anomalies of the aorta arch and improve prenatal detection of anomalies of the aorta arch.Methods One thousand four hundred and seventy-two cases fetus who were carried out detailed scan and whose results were confirmed were chose as study objects.Every routine fetal echocardiography included four chamber and left and right outflow tract and three-vessel trachea view(3VT).The more views which included longitudinal and coronary view of the aorta arch and coronary view of the trachea and main bronchus were obtained when the abnormality of aorta arch was suspected.Results One hundred and forty-eight cases with anomalies of aorta arch were diagnosed by ultrasonography.One case was misdiagnosed.Ninety-two fetus with anomalies of aorta arch which included 28 aortic coarctation(CoA) and 10 interrupted aortic arch (IAA) and 52 right-side aortic arch and abnormal aortic branch and 2 double aortic arch were confirmed by postmortem or postnatal echocardiography and surgery.Of the 92 confirmed cases,24 had prenatally diagnosed additional complex intracardiac anomalies.All cases with CoA and IAA presented ventricular and/or great arterial disproportion with smaller left ventricle and aorta diameter on four chamber view and 3VT.Right aortic arch (RAA) and abnormal aortic branch(AAB) displayed aortic arch located on the right side of the trachea and increased distance between the aortic arch and arterial duct and abnormal aortic arch branch-subclavian artery originating from the beginning section of the descend aorta which coursed behind the trachea with U-shaped appearance on the 3VT plane.The display rate of the transverse and longitudinal and coronary view of the aorta arch was 98.4%,90.0%,81.9%,respectively.Conclusions Disproportional ventricular and /or great arterial with smaller left ventricle and aorta diameter are the clues for CoA and IAA.Increased distance between the aortic arch and arterial duct is the clue for RSA.The transverse view of the aortic arch 3VT is the most sensitive for detecting the anomalies of the aortic arch and the most easily be obtained.The longitudinal and coronary view of the aorta arch and coronary view of the trachea and main bronchus are helpful in differentiating the anomalies of the aortic arch.