,

(Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, China)



Prenatal ultrasound in diagnosis of fetal aortic arch interruption

ZHANGYing*,WANGYu

(DepartmentofUltrasound,ShengjingHospitalofChinaMedicalUniversity,Shenyang110004,China)

ObjectiveTo analyze the ultrasonic characteristics in the diagnosis of fetal aortic arch interruption (IAA). MethodsThirty-five fetuses of IAA diagnosed prenatally were retrospectively reviewed, and 180 normal fetuses were also included. The visceral and cardiac positions were determined at first. A serial transverse views, including four chamber view, the left and right outflow tract views, the three-vessel view and the three-vessel-trachea view, were obtained by fetal 2D sonography. In addition, several sagittal views, including long axis view of vena cava, aortic arch view, and ductal arch view, were obtained. The ratio of left ventricle to right ventricle, and the ratio of aorta to pulmonary artery calculated in both IAA and normal fetuses, and then compared. ResultsA total of 16 fetuses, 18 fetuses, and 1 fetus of type A, type B, and type C IAA were prenatally diagnosed, respectively, and all with ventricular septal defect. Twenty-seven fetuses were confirmed by autopsy or postnatal echocardiography, 3 fetuses were misdiagnosed, and the other 5 cases were lost following up. Cross sectional scans found that the ratio of left ventricle to right ventricle and the ratio of aorta to pulmonary artery reduced, compared with normal fetuses with similar gestational ages (allP<0.01). Continuous sagittal scans played an important role in the determine of the branching of ascending aorta. Typical branches of ascending aorta presented as "W" type, "Y" type, and "I" type. The diagnostic rates of fetal IAA by the sagittal scans and the transverse scans were 90.00% (27/30) and 56.67% (17/30), respectively, and the difference was significant (P<0.01). ConclusionFetal 2D sonography can diagnose IAA with the sagittal scans and play the most important role. Abnormal signs presented in the cross sectional planes may suggest the possibility of IAA.

Fetus; Heart; Aortic arch interruption; Echocardiography

胎儿主动脉弓离断是一种罕见的先天性心脏病，在所有先天性心脏病中发病率不到1%[1]。主动脉弓发出3支头臂血管分别为头臂干、左颈总动脉及左锁骨下动脉。主动脉弓离断最常见于主动脉弓发出的左颈总动脉后中断(B型)，其次为发出的左锁骨下动脉后中断(A型)，主动脉弓发出头臂干后中断(C型)最为罕见[1-3]。此外，胎儿主动脉弓离断一般合并大小不等的室间隔缺损，还可合并其他多种心内畸形，如房间隔缺损、完全性大动脉转位、右心室双出口等[4-6]。目前，胎儿超声心动图是诊断胎儿先天性心脏病的主要手段。本研究对我院近年来诊断为主动脉弓离断的胎儿资料进行回顾性分析，分析该病的超声表现特点及诊断技巧。

1　资料与方法

1.1一般资料回顾性分析2006年1月—2014年12月在我院确诊为胎儿主动脉弓离断的35胎(病例组)胎儿资料，孕19～34周，平均(28.2±3.1)周；孕妇年龄20～38岁，平均(32.7±2.8)岁。另纳入2012年1月—2014年12月于我院门诊行常规检查的正常胎儿180胎(正常组)，孕19～34周，平均(27.3±1.9)周；孕妇年龄22～30岁，平均(26.4±3.5)岁。19～22、23～26、27～30、31～34孕周病例组和对照组分别有7、8、7及7胎和45、47、46及42胎，1例产后证实为主动脉弓缩窄的胎儿及5例失访胎儿未列入分析。

1.2仪器与方法采用GE Voluson E8三维彩色超声诊断仪，经腹三维容积探头，频率4～8 MHz。将动脉血流速度标尺设置为50～60 cm/s。获取胎儿纵断面并获取胎儿体位信息后，逆时针旋转探头声束90°并摆动探头分别获取胎儿上腹部及胸部横断面，以胎儿脊柱为界判断胎儿内脏及心脏位置。依次由下至上分别获取胎儿四腔心切面、左心室和右心室流出道切面、三血管切面及三血管-气管切面等心脏横断面，并在每个切面结合CDFI判断有无相应的心内畸形。……