Prenatal Findings in Total Anomalous Pulmonary Venous Return A Diagnostic Road Map Starts With Obstetric Screening Views
Prenatal Findings in Total Anomalous Pulmonary Venous Return A Diagnostic Road Map Starts With Obstetric Screening Views
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DOI：
10.7863/ultra.33.7.1193
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发表时间：
2014-07-01
影响因子：
2.3
通讯作者：
Moon-Grady, Anita J.
中科院分区：
文献类型：
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作者：
Ganesan, Suguna;Brook, Michael M.;Moon-Grady, Anita J.
目的：完全性肺静脉异位返流(TAPVR)的最佳围产期处理包括及时识别和手术矫正。然而，产前诊断长期以来一直是一项挑战。我们的目标是在大量的产前诊断和产后确诊的队列中确定一致的产前超声特征。方法：我们对2001-2012年间在我们机构帮助做出TAPVR诊断的二维和多普勒超声特征进行了系统的回顾。结果-26例患者产前诊断为TAPVR(平均胎龄24.1周)。在产前诊断为TAPVR的胎儿中，有4例为孤立病例；22例为异位综合征、额外的心脏异常，或两者兼而有之。产前诊断异常肺静脉引流：心上型18例，心上型1例，隔下型7例。最一致的表现是肺静脉与心房的连接不明显(100%)，四腔切面上可见静脉汇合(96%)。心脏不对称和在三支血管或腹部轴位上存在额外的垂直静脉通道也被注意到，但不太一致。26例胎儿中有25例存在肺静脉频谱多普勒异常表现。结论-TAPVR的诊断可在中期胎儿心脏产科筛查中所包括的标准轴位上予以怀疑，并在胎儿超声心动图上应用脉冲多谱勒成像加以证实。产科超声筛查可识别的线索有可能有助于提高TAPVR产前检测的诊断率。
Objectives-Optimal perinatal management of total anomalous pulmonary venous return (TAPVR) involves timely identification followed by surgical correction. Antenatal diagnosis, however, has long been a challenge. We aimed to identify consistent prenatal sonographic features in this condition in a large cohort in whom the diagnosis was made antenatally and confirmed postnatally.Methods-We conducted a systematic retrospective review of the 2-dimensional and Doppler sonographic features that had helped make the diagnosis of TAPVR at our institution from 2001 to 2012.Results-Twenty-six patients had prenatal diagnosis of TAPVR (mean gestational age, 24.1 weeks). Four of the fetuses with a prenatal diagnosis represented isolated cases of TAPVR; 22 had heterotaxy syndrome, additional cardiac abnormalities, or both. Prenatally diagnosed abnormal pulmonary venous connections were supracardiac (type I) in 18 cases, cardiac (type II) in 1, and infradiaphragmatic (type III) in 7. Lack of a visible connection of the pulmonary veins to the atrium (100%) and the presence of a visible venous confluence on axial 4-chamber views (96%) were the most consistent findings. Cardiac asymmetry and the presence of additional vertical venous channels on 3-vessel or axial abdominal views were also noted but less consistently. Abnormal pulmonary venous spectral Doppler findings were present in 25 of the 26 fetuses.Conclusions-The diagnosis of TAPVR can be suspected on standard axial views included in second-trimester obstetric screening examinations of the fetal heart and confirmed on fetal echocardiography with the use of pulsed wave Doppler imaging. Clues recognizable on obstetric sonographic screening have the potential to contribute to increasing the diagnostic yield for prenatal detection of TAPVR.