CAJ | 학술논문

目的探讨如何更好使用超声心动图筛查中晚孕胎儿心脏畸形,避免漏诊.方法超声筛查中晚期孕妇7020例,对检出的胎儿心脏畸形及可疑先天性心脏病者进行每4周一次追踪观察,对产前超声未发现心脏结构异常的胎儿进行每8周一次追踪观察,出生后每6个月一次追踪观察,至出生后6～12个月.所有异常胎儿均经尸检、出生后手术结果证实(部分术前行心血管造影).对比分析同类畸形产前超声诊断正确的经验与超声漏诊的教训.结果通过引产后病理证实或出生后心血管造影和(或)手术证实的53例心脏大血管异常中,产前超声检出并诊断正确43例,误诊2例,漏诊8例.误诊2例包括1例肺动脉瓣闭锁和1例法洛四联症.产前超声漏诊8例包括6例小于5 mm的室间隔缺损和2例下腔静脉异位引流.产前超声筛查胎儿心脏大血管畸形正确率为81.1％ (43/53).结论采用高频探头、图像的缩放功能以及注重右室流出道-肺动脉长轴切面和静脉-心房连接关系的扫查是避免漏诊或不全面诊断的重要因素.
목적 탐토여하경호사용초성심동도사사중만잉태인심장기형,피면루진.방법 초성사사중만기잉부7020례,대검출적태인심장기형급가의선천성심장병자진행매4주일차추종관찰,대산전초성미발현심장결구이상적태인진행매8주일차추종관찰,출생후매6개월일차추종관찰,지출생후6～12개월.소유이상태인균경시검、출생후수술결과증실(부분술전행심혈관조영).대비분석동류기형산전초성진단정학적경험여초성루진적교훈.결과 통과인산후병리증실혹출생후심혈관조영화(혹)수술증실적53례심장대혈관이상중,산전초성검출병진단정학43례,오진2례,루진8례.오진2례포괄1례폐동맥판폐쇄화1례법락사련증.산전초성루진8례포괄6례소우5 mm적실간격결손화2례하강정맥이위인류.산전초성사사태인심장대혈관기형정학솔위81.1％ (43/53).결론 채용고빈탐두、도상적축방공능이급주중우실류출도-폐동맥장축절면화정맥-심방련접관계적소사시피면루진혹불전면진단적중요인소.
Objective To investigate the application of prenatal ultrasonograpy in diagnosis of fetal heart disease during the medium-term and terminal pregnancy,and to avoid misdiagnosis.Methods The prenatal ultrasonographic screening was conducted in 7020 pregnant women with medium-term and terminal pregnancy.All confirmed and suspicious cases of fetal heart disease were observed by echocardiography once 4 weeks until postnatal sixth month to 1 year while normal cases was traced at the intervals of 8 weeks.All the cases were confirmed by autopsy or surgery while part of them were confirmed by postnatal angiocardiography before surgery.The reasons of misdiagnosis were analyzed.Results In fifty-three cases of fetal cardiovascular abnormality,43 cases were found,2 cases were misdiagnosis while 8 cases were missed diagnosis.2 cases of misdiagnosis included 1 case of pulmonary valve stenosis and 1 case of tetralogy of Fallot.8 cases of miss diagnosis included 2 cases of inferior vena cava in ectopic drainage and 6 cases of ventricular septal defect (defect diameter ＜ 5 mm).The accuracy rate of diagnosis of fetal heart disease was 81.1 ％ by echocardiography.Conclusions Using high frequency probe,image zoom,enhancing the detection of vein-atrium connection and the structure of right ventricular outflow with pulmonary artery are important factors to avoid missed diagnosis and incomplete diagnosis.