Comparison of echocardiographic findings of fetal pulmonary stenosis before and after delivery

Jianjun Liu; Yanli Guo; Lingmin Duan; Yafang Xue; Fenglian Deng; Yan Wang; Hua Zhong

doi:10.16016/j.1000-5404.201701002

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Comparison of echocardiographic findings of fetal pulmonary stenosis before and after delivery

Clinical Medicine | 更新时间：2026-01-09

- Comparison of echocardiographic findings of fetal pulmonary stenosis before and after delivery
- Journal of Third Military Medical University Vol. 39, Issue 12, Pages: 1268-1274(2017)
- 作者机构：
  
  400038 重庆，第三军医大学西南医院超声科
- 作者简介：
- 基金信息：
  
  "Twelfth Five-year Plan" for National Key Technology R & D Program(2014BA106B00);Science and Technology Wellbeing Project of Chongqing(CSTC2015jcsf40001)
- DOI：10.16016/j.1000-5404.201701002
  CLC： R445.1;R714.5;R725.432
- Received：01 January 2017，
  
  Revised：2017-03-08，
  
  Published：30 June 2017
- 稿件说明：
移动端阅览
Jianjun Liu, Yanli Guo, Lingmin Duan, et al. Comparison of echocardiographic findings of fetal pulmonary stenosis before and after delivery[J]. Journal of Third Military Medical University, 2017, 39(12): 1268-1274.
DOI：

Jianjun Liu, Yanli Guo, Lingmin Duan, et al. Comparison of echocardiographic findings of fetal pulmonary stenosis before and after delivery[J]. Journal of Third Military Medical University, 2017, 39(12): 1268-1274. DOI： 10.16016/j.1000-5404.201701002.

摘要

目的

探讨胎儿肺动脉狭窄产前及产后超声心动图的变化规律。

方法

选择2014年6月至2016年6月我院经超声诊断或怀疑肺动脉狭窄的胎儿16例，出生后进行随访。对照分析胎儿产前及产后肺动脉狭窄超声心动图的声像图特征，探讨胎儿肺动脉狭窄产前及产后血流动力学变化规律，对漏诊和误诊病例进行分析。

结果

16例胎儿出生后1个月内进行随访，超声心动图证实13例新生儿存在不同程度的肺动脉狭窄，其中10例为单纯性肺动脉瓣狭窄：重度狭窄者具有典型的声像图特征，均伴有三尖瓣重度反流、右房大、右室小、动脉导管血流反向，预后较差；轻度和中度狭窄者产前超声图像特征不明显而容易漏诊，产后随访其狭窄程度可逐渐减轻，2例进行性加重。3例为肺动脉主干狭窄且伴有心内畸形，产前及产后超声表现一致，预后较差。另有3例产前诊断为肺动脉主干轻度狭窄，出生后超声心动图显示肺动脉正常。

结论

胎儿肺动脉狭窄产前和产后血流动力学具有特征性改变，需要对胎儿肺动脉狭窄进行产前及产后超声心动图动态随访，评估其狭窄程度和预后。

Abstract

Objective

To compare the echocardiographic characteristics of fetal pulmonary stenosis before and after delivery.

Methods

Sixteen fetuses with a confirmed or suspected diagnosis of pulmonary stenosis by echocardiography in our department from June 2014 to June 2016 were analyzed. The sonographic features of pulmonary stenosis in echocardiography and the hemodynamic parameters before and after delivery were compared. The misdiagnosis and missed diagnosis were analyzed in these cases.

Results

Within 1 month after birth

echocardiography confirmed pulmonary stenosis in 13 newborns

including 10 with uncomplicated pulmonary valve stenosis. The cases with severe pulmonary stenosis showed characteristic echocardiographic features

including severe tricuspid regurgitation

a large right atrium

a small right ventricle

and retrograde blood flow in the arterial duct

which were all associated with a poor prognosis. In cases with mild or moderate pulmonary stenosis

prenatal echocardiography showed no characteristic findings to easily cause missed diagnosis

and follow-up echocardiography may show gradual alleviation of the stenosis

but in 2 cases

the condition could deteriorate progressively. Three cases were confirmed to have pulmonary stenosis with concurrent intracardiac malformation and consistent pre-and postnatal echocardiographic findings

and all these 3 cases had a poor prognosis. In another 3 cases

echocardiography after delivery showed normal pulmonary artery although they were diagnosed to have mild pulmonary stenosis by prenatal echocardiography.

Conclusion

The hemodynamics of fetal pulmonary artery stenosis can present with characteristic changes in echocardiography after birth

suggesting the need of close and regular echocardiographic follow-up of the fetuses to assess the changes of stenosis and the prognosis.

关键词

Keywords

references

董凤群, 赵真.先天性心脏病实用超声诊断学[M].第2版.北京:人民军医出版社, 2011: 67-72.

Dong F Q, Zhao Z. Practical clinical ultrasonic diagnosis of congenital heart diseases[M]. 2nd ed. Beijing: People's Military Medical Press, 2011: 67-72.

接连利, 许燕, 程建, 等.胎儿单纯性肺动脉狭窄的声像图特征及其诊断价值[J].中华超声影像学杂志, 2012, 21(12): 1082-1083. DOI: 10.3760/cma.j.issn 1004-4477.2012.12.024.

Jie L L, Xu Y, Cheng J, et al. Characteristics and diagnostic value of ultrasonogram for fetal simple pulmonary artery stenosis [J]. Chin J Ultrasonogr, 2012, 21(12): 1082-1083. DOI: 10.3760/ cma.j.issn 1004-4477.2012.12.024.

贾琳, 李军, 周晓东, 等.二维及多普勒超声心动图诊断先天性单纯性肺动脉瓣狭窄[J].心脏杂志, 2001, 13(2): 158-159. DOI: 10.3969/j.issn.1009-7236.2001.02.034.

Jia L, Li J, Zhou X D, et al. Two-dimensional and doppler echocardiography in the diagnosis of congenital simple pulmonary stenosis[J]. Chin Heart J, 2001, 13(2): 158-159. DOI:10.3969/j.issn.1009-7236.2001.02.034.

刘友兰, 肖莹, 胡雪飞.胎儿肺动脉狭窄的超声特征[J].医学临床研究, 2014, 31(2): 83-384. DOI: 10.3969/j.issn.1671-7171.2014.02.064.

Liu Y L, Xiao Y, Hu X F. The ultrasonic characteristics of fetal pulmonary stenosis[J]. J Clin Res, 2014, 31(2): 383-384. DOI: 10.3969/j.issn.1671-7171.2014.02.064.

寿列军, 解左平, 沈晓燕, 等.超声诊断胎儿单纯性肺动脉狭窄产前及产后对照分析及漏诊应对[J].中国优生与遗传杂志, 2015, 23(8): 98-99. DOI: 10.13404/j.cnki.cjbhh.2015.08.044.

Shou L J, Xie Z P, Shen X Y, et al. Comparison of prenatal and postpartum ultrasonic diagnosis for pulmonary artery stenosis and strategies for missed diagnosis[J]. Chin J Birth Health Heredity, 2015, 23(8): 98-99. DOI: 10.13404/j.cnki.cjbhh.2015.08.044.

Peterson R E, Levi D S, Williams R J, et al. Echocardiographic predictors of outcome in fetuses with pulmonary atresia with intact ventricular septum[J]. J Am Soc Echocardiogr, 2006, 19(11): 1393-1400. DOI: 10.1016/j.echo.2006.05.021.

Favilli S, Giusti S, Vangi V, et al. Pulmonary atresia or critical pulmonary stenosis with intact interventricular septum diagnosed in utero: echocardiographic findings and post-natal outcome[J]. Pediatr Med Chir, 2003, 25(4): 266-268.

张烨, 何怡华, 孙琳, 等.胎儿动脉导管血流频谱与右室梗阻性疾病肺动脉发育相关分析[J].中国超声医学杂志, 2015, 31(4): 355-357.

Zhang Y, He Y H, Sun L, et al. Analysis of the relationship between reverse ductus arteriosus flow and pulmonary development of fetal with right ventricular obstructive lesions [J]. Chin J Ultrasound Med, 2015, 31(4): 355-357.

接连利, 刘清华, 许燕, 等.胎儿肺动脉狭窄的超声诊断价值[J].中华超声影像学杂志, 2006, 15(1): 68-69. DOI: 10.3760/j.issn:1004-4477.2006.01.019.

Jie L L, Liu Q H, Xu Y, et al. Diagnostic value of ultrasonogram for fetal simple pulmonary artery stenosis [J]. Chin J Ultrasonogr, 2006, 15(1): 68-69. DOI: 10.3760/j.issn:1004-4477.2006.01.019.

李治安.临床超声影像学[M].北京:人民卫生出版社, 2003: 640-643.

Li Z A. Clinical ultrasound imaging[M]. Beijing: People's Medical Publising House, 2003: 640-643.

谢乐燕, 解左平, 金社红, 等.胎儿右心室发育不良的产前超声诊断价值[J].中国优生与遗传杂志, 2016, 24(1): 87-87. DOI: 10.13404/j.cnki.cjbhh.2016.01.034.

Xie L Y, Xie Z P, Jin S H, et al. Fetal prenatal ultrasound diagnosis value of right ventricular dysplasia[J]. Chin J Birth Health Hered, 2016, 24(1): 87-87. DOI: 10.13404/j.cnki.cjbhh.2016.01.034.

Vi als F, Heredia F, Giuliano A. The role of the three vessels and trachea view (3VT) in the diagnosis of congenital heart defects[J]. Ultrasound Obstet Gynecol, 2003, 22(4): 358-367. DOI: 10.1002/uog.882.

钱小华, 金建文.产科超声三血管切面发现胎儿肺动脉异常的临床分析[J].中国妇幼健康研究, 2016, 27(5): 637-639. DOI: 10.3969/j.issn.1673-5293.2016.05.030.

Qian X H, Jin J W. Clinical analysis of abnormal pulmonary artery in fetus detected by obstetric ultrasound from three vessel trachea views [J]. Chin J Woman Child Health Res, 2016, 27(5): 637-639. DOI: 10.3969/j.issn.1673-5293.2016.05.030.

卫云峰, 张海峰, 丁倩.超声心动图对胎儿单纯肺动脉狭窄的诊断价值[J].临床超声医学杂志, 2015, 17(8): 571-572. DOI: 10.16245/j.cnki.Issn 1008-6978.2015.08.033.

Wei Y F, Zhang H F, Ding Q.Diagnostic value of echocardiography for fetal simple pulmonary artery stenosis[J]. J Clin Ultrasound in Med, 2015, 17(8): 571-572. DOI: 10.16245/j.cnki.issn 1008-6978.2015.08.033.

接连利, 刘清华, 许燕.胎儿心脏病理解剖与超声诊断学[M].北京:人民卫生出版社, 2010: 134-144.

Jie L L, Liu Q H, Xu Y, Pathological anatomy and ultrasonography of fetal heart [M]. Beijing: People's Medical Publising House, 2010: 134-144.

赵一理, 蔡爱露, 张颖, 等.肺动脉狭窄胎儿静脉导管的血流频谱特征[J].中国医学影像技术, 2010, 26(7): 1314-1317.

Zhao Y L, Cai A L, Zhang Y, et al. Ductus venous flow waveforms in fetuses with pulmonary stenosis[J]. Chin J Med Imaging Technol, 2010, 26(7): 1314-1317.

陆红好, 赵博文, 潘美, 等.超声心动图定量胎儿主动脉和肺动脉内径Z评分的研究[J].中华超声影像学杂志, 2013, 22(2): 111-114. DOI: 10.3760/ema.j.issn.1004-4477.2013.02.006.

Lu H Y, Zhao B W, Pan M, et al. Quantification of z-scores of fetal aortic and pulmonary artery diameters using echocardiography[J]. Chin J Ultrasonography, 2013, 22(2): 111-114. DOI: 10.3760/ema.j.issn.1004-4477.2013.02.006.

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