CAJ | 학술논문

目的：总结冠状动脉瘘胎儿超声心动图特征及临床意义。方法对南京医科大学附属苏州医院2011年1月至2012年12月诊断为冠状动脉瘘的5例胎儿超声心动图特征及随访结果进行总结分析。结果5例冠状动脉瘘胎儿产前超声心动图特征：心尖四腔观及左心室流出道观声像图示冠状动脉扩张，追踪其走行，可发现心腔及大血管的瘘口分别位于左心室流出道主动脉根部、房间隔右心房侧、右心房上腔静脉入口处、右心室心尖部及右心室圆锥部。彩色多普勒超声显示冠状动脉内为高速湍流信号；频谱多普勒测得双期双向血流信号。其中1例合并其他心脏复杂畸形，1例合并永存左上腔静脉。5例胎儿中4例随访至产后，超声心动图检查证实新生儿为右冠状动脉瘘；1例胎儿引产后失访，未尸检。结论胎儿冠状动脉瘘有特征性超声心动图表现，产前早期发现对出生后患儿早期治疗有重要临床意义。
목적：총결관상동맥루태인초성심동도특정급림상의의。방법대남경의과대학부속소주의원2011년1월지2012년12월진단위관상동맥루적5례태인초성심동도특정급수방결과진행총결분석。결과5례관상동맥루태인산전초성심동도특정：심첨사강관급좌심실류출도관성상도시관상동맥확장，추종기주행，가발현심강급대혈관적루구분별위우좌심실류출도주동맥근부、방간격우심방측、우심방상강정맥입구처、우심실심첨부급우심실원추부。채색다보륵초성현시관상동맥내위고속단류신호；빈보다보륵측득쌍기쌍향혈류신호。기중1례합병기타심장복잡기형，1례합병영존좌상강정맥。5례태인중4례수방지산후，초성심동도검사증실신생인위우관상동맥루；1례태인인산후실방，미시검。결론태인관상동맥루유특정성초성심동도표현，산전조기발현대출생후환인조기치료유중요림상의의。
Objective To summarize the echocardiographic characteristics and clinical signiifcance of prenatal diagnosis of coronary artery ifstula (CAF). Methods Images and follow-up results of ifve fetuses with CAF diagnosed by fetal echocardiography between January, 2011 and December, 2012 in our department were reviewed. Results Echocardiographic characteristics of CAF were a dilated coronary artery in the four chamber view and the left ventricular outlfow tract view. Track the course of the dilated coronary artery can conifrm the oriifce of the ifstula. Among the ifve cases, the oriifce of the ifstula included the aortic root of left ventricular outlfow tract, right atrium side of interatrial septum, the entrance of superior vena cava to right atrium, right ventricular apex and right ventricle cone. The colour Doppler lfow imaging showed turbulence in the dilated coronary artery. The spectral Doppler with the sampling gate in coronary artery showed the characteristic bidirectional lfow pattern. One case was associated with other complex intracardiac abnormalities and one case with persistent left superior vena cava. Among the ifve cases of CAF diagnosed by fetal echocardiography, one case was missed and four cases were conifrmed by postnatal echocardiography. Conclusion Coronary artery ifstula has special fetal echocardiographic characteristics. The fetal echocardiography plays an important role in early detection, diagnosis and treatment of CAF.