| 吴瑛,刘涛,熊奕,王慧芳,林琪,林琳华.胎儿心轴异常——先天性心脏病和胸腹病变的诊断线索[J].中国医学影像技术,2007,23(7):1059~1061 |
| 胎儿心轴异常——先天性心脏病和胸腹病变的诊断线索 |
| Abnormal fetal cardiac axis: a clue for congenital heart disease and extracardiac anomalies |
| 投稿时间：2007-01-16 修订日期：2007-06-08 |
| DOI： |
| 中文关键词: 胎儿 超声检查 先天性心脏病 心轴 |
| 英文关键词:Fetus Ultrasonography Congenital heart disease Cardiac axis |
| 基金项目:国家人口和计划生育委员会三大工程项目(人口科函【2006】14号,NO.C1-60)。 |
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| 中文摘要: |
| 目的 探讨胎儿心轴异常在先心病和胸腹病变超声诊断中的意义。方法 中孕期经超声检查的173例正常胎儿和54例先心病、10例胸腹病变胎儿,分为三组, 在四腔心切面上进行心轴角度的测量和分析。结果 正常胎儿的平均心轴角度为(41.1±8.2)°,先心病组为(51.4±18.3)°,与正常组相比有显著性差异(P<0.0001),其中左心发育不良综合征、心内膜垫缺损、右室双出口等病种合并心轴异常的比例较高。胸腹病变组平均心轴角度为(59.7±15.9)°,与正常组相比有显著性差异(P<0.001),导致心轴异常的病种主要为膈疝和腹腔内脏外翻。按超过正常胎儿99%正常值范围(20.3°~61.9°)为异常心轴统计,心轴左偏(>62°)在三组中分别为1/173(0.6%),16/54(29.6%)和1/10(10.0%);心轴右偏(<20°) 在三组中分别为0,6/54(11.1%)和3/10(30.0%)。结论 中孕期胎儿心轴角度的测定简单易行,当其<20°或>62°时提示可能存在心脏畸形或胸腹腔病变,应进一步检查确诊。 |
| 英文摘要: |
| Objective To ascertain the clinical significant of the cardiac axis for the prenatal detection of congenital heart defects and extracardiac anomalies. Methods Fetal cardiac axis was measured using an image of the four-chamber view of the heart in second-trimenster. 54 fetuses had heart defects, and 10 fetuses had intrathoricic or abdominal anomalies. The control group consisted of 173 consecutive fetuses with normal sonographic structural surveys. Results The 54 fetuses with heart defects had a mean cardiac axis of (51.4±18.3)°, compared with in normal fetuses (41.1±8.2)°(P<0.0001). The frequency of cardiac rotation was greater in fetuses with hypoplastic left heart, atrioventricular canal and double outlet right ventricles. Ten fetuses with intrathoricic or abdominal anomalies had a mean cardiac axis 59.7°±15.9°, significantly larger axis than normal (P<0.001), especially in diaphragmatic hernia, omphalocele or gastroschisis. Using above or below the 99% normal range (20.3~61.9)° of normal group as the abnormal axis, three groups fetuses were identified with levorotation of the cardiac axis (＞62°) in 1/173 (0.6%), 16/54 (29.6%) and 1/10 (10.0%). Smaller than normal (<20°) or right cardiac axis were in none of normal group, 6/54(11.1%) and 3/10 (30.0%) in abnormal axis group. Conclusion The measurement of fetal cardiac axis is simple and effect. The presence of a abnormal cardiac axis (<20° or ＞62°) in the fetuses is associated with a substantial risk of congenital heart disease and/or severe extracardiac defects. The finding of an abnormal axis should prompt further evaluation of the fetal heart and a detailed anatomical examination. |
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