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目的探讨胎儿先天性半月瓣缺如产前超声声像图特征。方法对2010年1月至2015年12月孕11~13+6周在深圳市妇幼保健院和广西壮族自治区妇幼保健院产前超声检出半月瓣缺如的41例胎儿超声心动图像特征及临床结局进行总结分析。结果 41例半月瓣缺如胎儿中肺动脉瓣缺如28例(68.2%),主动脉瓣缺如1例(2.4%);肺动脉瓣联合主动脉瓣缺如12例(29.4%)。早孕期超声检出胎儿半月瓣缺如21例(51.2%),其中肺动脉瓣联合主动脉瓣缺如均于早孕期超声心动图检出。二维超声显示20例胎儿颈项透明层(NT)增厚,1例胎儿因合并颅脑及神经管畸形NT值正常,15例合并胎儿水肿,6例合并颈部水囊瘤,16例心脏增大;超声心动图表现为三血管气管观可动态观察到主动脉和(或)肺动脉红蓝交替往返血流信号,即“进出征”。中孕期超声检出胎儿半月瓣缺如20例(48.8%),二维超声显示胎儿合并心外畸形6例。超声心动图多表现为主动脉和(或)肺动脉扩张,瓣环内无明显瓣叶启闭。超声随访过程中3例胎死宫内(均为肺动脉瓣联合主动脉瓣缺如);38例胎儿母亲选择性引产,全组均无存活病例。引产后尸检诊断与产前超声检查结果一致。结论先天性半月瓣缺如胎儿有特征性产前超声表现,早孕期发现颈项透明层增厚,三血管气管观显示主动脉和(或)肺动脉红蓝交替往返血流信号,即有典型“进出征”等图像特征,可早期诊断本病。
Objective To investigate the features of fetal congenital semilunar defects such as prenatal ultrasonography. Methods From January 2010 to December 2015, from January 11 to December 13, 2006, 41 cases of fetal echocardiographic features of prenatal ultrasound in maternal and child health care hospital of Shenzhen and Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region were enrolled. Final analysis. Results There were 41 cases of semilunar defects, such as 28 cases (68.2%) with pulmonary insufficiency in the fetus, 1 case (2.4%) lacking aortic valve, and 12 cases (29.4%) missing pulmonary valve combined with aortic valve. In early pregnancy, 21 cases (51.2%) were diagnosed as absence of fetal semilunar valve, and pulmonary valve combined with absence of aortic valve were detected by echocardiography in early pregnancy. Two-dimensional ultrasonography showed thickening of the fetal neck tunicate (NT) in 20 cases, normal NT value in 1 fetus with craniocerebral and neural tube defects, 15 cases with fetal edema, 6 cases with cervical cyst and 16 cases with cardiac enlargement Large; echocardiography showed a three-vessel tracheal observation can be dynamically observed aortic and (or) red and blue pulmonary artery alternating blood flow signal, that is, “entry and exit sign.” In the second trimester of pregnancy, 20 cases (48.8%) were diagnosed as missing semilunar valve by ultrasound, and 6 cases were diagnosed as fetus with extracardiac deformity by two-dimensional ultrasonography. Echocardiography and more performance of the aorta and (or) pulmonary artery dilatation, no significant valve flap opening and closing within the valve leaflets. During the follow-up of ultrasound, 3 cases of intrauterine fetal death (both pulmonary valve flaps combined with aortic valve defect); 38 cases of fetus mother induced abortion, all without survivors. Postmortem autopsy diagnosis and prenatal ultrasound findings consistent. Conclusions The congenital semilunar defect is characterized by prenatal ultrasound manifestations of the fetus, early pregnancy found thickening of the transparent layer of the neck, the three vascular trachea shows the aorta and / or pulmonary artery red and blue alternating blood flow signals, that is typical “ In and out ”and other image features, early diagnosis of the disease.