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目的:明确各孕周胎儿超声心动图四腔观、腹部横断面观等切面显示率,探讨孕早期超声心动图对超声软指标阳性胎儿复杂先天性心脏病(CHD)的诊断价值。方法:用GE Voluson E8彩色超声诊断仪(探头频率4~8 MHz)对120例超声软指标阳性胎儿进行孕早期(11~13+6周)超声心动图检查,探查胎儿方位、腹部大血管位置、心脏位置、心尖指向及超声心动图各切面,判断胎儿心脏结构是否正常,将检查结果与引产病理尸检、孕中期(孕18~24周)复查或分娩后新生儿期超声心动图检查结果作对照,并以ROC曲线分析孕早期超声心动图的灵敏度和特异度。结果:孕早期胎儿超声心动图对胎儿心脏四腔观、腹部横断面观、动脉导管弓观、左心室流出道观、主动脉弓观、三血管气管观、上下腔静脉长轴观的显示率均随孕周的增加而提高,分别为72.7%、89.2%、80.0%、65.8%、70.0%、72.5%、74.2%。胎儿孕早期超声心动图对复杂性CHD的灵敏度为86.4%(19/22),特异度为96.7%(87/90),准确度为72.7%(16/22),ROC曲线下面积(AUC)为0.81。结论:孕早期胎儿超声心动图对各切面的显示率随孕周的增加而提高,且超声图像特征基本同于孕中期超声检查。孕早期超声心动图筛查复杂性CHD胎儿特异性好,灵敏度及准确度均较高,对于部分复杂性CHD胎儿可作出提示性诊断,对减少先天性畸形胎儿出生率有重要意义。
OBJECTIVE: To determine the rate of four-chamber fetal echocardiography at different gestational weeks and to evaluate the diagnostic value of echocardiography in the diagnosis of complex fetal congenital heart disease (CHD) with fetal soft-positive fetus in early pregnancy. Methods: Echocardiography was performed during the first trimester (11 ~ 13 + 6 weeks) in 120 fetuses with ultrasound soft-labeled fetuses by using GE Voluson E8 color ultrasonic diagnostic apparatus (probe frequency 4-8 MHz) to explore the fetal position, abdominal large vessel position , Cardiac position, apical point and echocardiography to determine whether the fetal heart structure is normal, the test results and induced abortion pathological autopsy, the second trimester (18 to 24 weeks of pregnancy) review or postpartum neonatal echocardiography results The sensitivity and specificity of early echocardiography were analyzed by ROC curves. Results: Fetal echocardiography in fetal heart rate in early pregnancy showed no significant difference in gestational age, gestational age, gestational age, gestational age, Week increase of 72.7%, 89.2%, 80.0%, 65.8%, 70.0%, 72.5%, 74.2% respectively. The sensitivity, specificity and accuracy of fetal echocardiography for complex CHD were 86.4% (19/22), 96.7% (87/90), 72.7% (16/22) respectively. The area under the curve of ROC (AUC) Is 0.81. Conclusion: The display rate of fetal echocardiography in each section increased with gestational age in early pregnancy, and the characteristics of ultrasound images were basically the same as that of the second trimester. In the first trimester of pregnancy, the CHD fetus has good fetal specificity, high sensitivity and high accuracy, which can be used as a diagnostic tool for CHD fetuses with some complex features. It is of great significance to reduce the birth rate of congenital malformation fetus.