CAJ | 학술논문

目的探讨体外受精-胚胎移植（IVF-ET）妊娠的心脏病胎儿超声心动图特征及分类情况的特殊性。方法对2011年1月至2013年6月孕18~24周在南京军区福州总医院行胎儿超声心动图检查的IVF-ET妊娠孕妇1129例，分析IVF-ET妊娠胎儿先天性心脏病超声表现及分类特征，并对部分检出胎儿心脏病的孕妇选择性进行羊水穿刺术，追踪所有入选孕妇的妊娠过程及胎儿临床结局。结果1129例接受IVF-ET的孕妇中单胎妊娠953例、双胎妊娠176例，共检测胎儿1305个，其中超声心动图诊断胎儿心脏畸形15例（1.1%，15/1305），临床确诊15例。IVF-ET心脏畸形胎儿超声心动图表现：（1）法洛四联症5例，超声心动图示胎儿主动脉增宽伴骑跨，室间隔缺损，肺动脉狭窄，右心室肥厚。（2）左心发育不良综合征1例，超声心动图示胎儿左心明显缩小，二尖瓣闭锁，右心扩大，肺动脉扩张。（3）完全型房室间隔缺损1例，超声心动图示胎儿心内膜正常十字交叉结构消失，房室共瓣。（4）大动脉共干Ⅰ型1例，超声心动图示胎儿心底部仅见1条大血管，短小的肺动脉主干自大动脉发出，并见室间隔缺损。（5）主动脉狭窄及缩窄各1例，超声心动图示1例胎儿主动脉瓣增厚，升主动脉增宽；1例胎儿主动脉峡部狭窄伴狭窄后扩张。（6）肺动脉狭窄2例，超声心动图示胎儿肺动脉瓣狭窄伴狭窄后肺动脉扩张。（7）室间隔缺损3例，超声心动图示胎儿室间隔连续中断，断端边缘回声增强。超声漏诊胎儿室间隔小缺损1例，为出生后超声心动图检查发现。结论 IVF-ET妊娠胎儿较自然妊娠胎儿先天性心脏病的发生率高，IVF-ET妊娠胎儿与自然妊娠胎儿先天性心脏病的超声心动图表现相同。其中以法洛四联症和室间隔缺损最多见。对IVF-ET妊娠胎儿行超声心动图检查能全面系统评价IVF-ET妊娠胎儿心脏异常的情况，有重要临床指导意义。目的探討體外受精-胚胎移植（IVF-ET）妊娠的心髒病胎兒超聲心動圖特徵及分類情況的特殊性。方法對2011年1月至2013年6月孕18~24週在南京軍區福州總醫院行胎兒超聲心動圖檢查的IVF-ET妊娠孕婦1129例，分析IVF-ET妊娠胎兒先天性心髒病超聲錶現及分類特徵，併對部分檢齣胎兒心髒病的孕婦選擇性進行羊水穿刺術，追蹤所有入選孕婦的妊娠過程及胎兒臨床結跼。結果1129例接受IVF-ET的孕婦中單胎妊娠953例、雙胎妊娠176例，共檢測胎兒1305箇，其中超聲心動圖診斷胎兒心髒畸形15例（1.1%，15/1305），臨床確診15例。IVF-ET心髒畸形胎兒超聲心動圖錶現：（1）法洛四聯癥5例，超聲心動圖示胎兒主動脈增寬伴騎跨，室間隔缺損，肺動脈狹窄，右心室肥厚。（2）左心髮育不良綜閤徵1例，超聲心動圖示胎兒左心明顯縮小，二尖瓣閉鎖，右心擴大，肺動脈擴張。（3）完全型房室間隔缺損1例，超聲心動圖示胎兒心內膜正常十字交扠結構消失，房室共瓣。（4）大動脈共榦Ⅰ型1例，超聲心動圖示胎兒心底部僅見1條大血管，短小的肺動脈主榦自大動脈髮齣，併見室間隔缺損。（5）主動脈狹窄及縮窄各1例，超聲心動圖示1例胎兒主動脈瓣增厚，升主動脈增寬；1例胎兒主動脈峽部狹窄伴狹窄後擴張。（6）肺動脈狹窄2例，超聲心動圖示胎兒肺動脈瓣狹窄伴狹窄後肺動脈擴張。（7）室間隔缺損3例，超聲心動圖示胎兒室間隔連續中斷，斷耑邊緣迴聲增彊。超聲漏診胎兒室間隔小缺損1例，為齣生後超聲心動圖檢查髮現。結論 IVF-ET妊娠胎兒較自然妊娠胎兒先天性心髒病的髮生率高，IVF-ET妊娠胎兒與自然妊娠胎兒先天性心髒病的超聲心動圖錶現相同。其中以法洛四聯癥和室間隔缺損最多見。對IVF-ET妊娠胎兒行超聲心動圖檢查能全麵繫統評價IVF-ET妊娠胎兒心髒異常的情況，有重要臨床指導意義。
목적탐토체외수정-배태이식（IVF-ET）임신적심장병태인초성심동도특정급분류정황적특수성。방법대2011년1월지2013년6월잉18~24주재남경군구복주총의원행태인초성심동도검사적IVF-ET임신잉부1129례，분석IVF-ET임신태인선천성심장병초성표현급분류특정，병대부분검출태인심장병적잉부선택성진행양수천자술，추종소유입선잉부적임신과정급태인림상결국。결과1129례접수IVF-ET적잉부중단태임신953례、쌍태임신176례，공검측태인1305개，기중초성심동도진단태인심장기형15례（1.1%，15/1305），림상학진15례。IVF-ET심장기형태인초성심동도표현：（1）법락사련증5례，초성심동도시태인주동맥증관반기과，실간격결손，폐동맥협착，우심실비후。（2）좌심발육불량종합정1례，초성심동도시태인좌심명현축소，이첨판폐쇄，우심확대，폐동맥확장。（3）완전형방실간격결손1례，초성심동도시태인심내막정상십자교차결구소실，방실공판。（4）대동맥공간Ⅰ형1례，초성심동도시태인심저부부견1조대혈관，단소적폐동맥주간자대동맥발출，병견실간격결손。（5）주동맥협착급축착각1례，초성심동도시1례태인주동맥판증후，승주동맥증관；1례태인주동맥협부협착반협착후확장。（6）폐동맥협착2례，초성심동도시태인폐동맥판협착반협착후폐동맥확장。（7）실간격결손3례，초성심동도시태인실간격련속중단，단단변연회성증강。초성루진태인실간격소결손1례，위출생후초성심동도검사발현。결론 IVF-ET임신태인교자연임신태인선천성심장병적발생솔고，IVF-ET임신태인여자연임신태인선천성심장병적초성심동도표현상동。기중이법락사련증화실간격결손최다견。대IVF-ET임신태인행초성심동도검사능전면계통평개IVF-ET임신태인심장이상적정황，유중요림상지도의의。
Objective To evaluate the manifestation and classiifcation of fetal congenital heart disease of in vitro fertilization-embryo transfer (IVF-ET) in echocardiography. Methods One thousand one hundred and twenty-nine IVF-ET pregnant women undergone echocardiography between 18-24 weeks gestation from Jan 2011 to Jun 2013 were studied. In Fuzhou General Hospital of Nanjing Command, we analyzed manifestation and classiifcation of fetal congenital heart disease in echocardiography, performed amniocentesis selectively and followed entire pregnancy and clinical outcome of all pregnant women selected. Results There were 953 cases of single pregnancy and 176 cases of gemellary pregnancy, and 1 305 fetus were obtained. Fifteen cases were diagnosed congenital heart diseases by echocardiography (1.1%, 15/1 305) and 15 cases were diagnosed congenital heart disease by clinic. Manifestations in echocardiography of fetal congenital heart disease were as followed:(1) Five cases of tetralogy of Fallot showed:aorta widened with ride across, ventricular septal defect, pulmonary stenosis and right ventricular hypertrophy. (2) One case of hypoplastic left heart syndrome showed:signiifcant reduction of left heart, mitral valve atresia, right heart enlargement and dilation of pulmonary artery. (3) One case of complele atrioventricular septal defect showed:disappeared of endocardial cross structure, common atrioventricular valve. (4) One case of truncus arteriosus-I showed:only one great vessel in heart bottom, short and pulmonary artery trunk from the aorta smallish main pulmonary artery started from main artery and ventricular septal defect. (5) Each one case of aortic stenosis and aortic coarctation showed:one with thicken aortic valve and widened ascending aorta, the other with aortic isthmus stenosis followed by dilatation. (6) Two cases of pulmonary artery stenosis showed:pulmonary valve stenosis followed by diatation. (7) Three cases of ventricular septal defect showed:ventricular septal interruption and echo increased of broken ends margin. One case of small ventricular septal defect was misdiagnosised. Conclusions Incidence rate of fetal congenital heart disease in IVF-ET pregnancy were higher than that of natural pregnancy. The echocardiography manifestation of fetal congenital heart disease of IVF-ET pregnancy was same as that of natural pregnancy. Tetralogy of Fallot and ventricular septal defect were the most common classiifcations. Prenatal echocardiography can give a systematic and comprehensive evaluation of fetal heart abnormality in IVF-ET pregnancy and will provide an important guidance to clinic.