胎儿心脏超声检查入门

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1、APrimerforFetalCardiacImagingAStepwiseApproachfor2-DimensionalImaging(UltrasoundQuarterly2008;24:195Y206)AmericanInstituteofUltrasoundinMedicine(AIUM)andtheInternationalSocietyofUltrasoundinObstetricsandGynecologyoutlinedrecentguidelinesforsonographicevaluationofthefetalheart.TheInternationalSocie

2、tyofUltrasoundinObstetricsandGynecologyguidelinesincludethe“basic”cardiacexaminationthatreliesona4-chamberview.Therearekeyfeaturesofthissonographicviewthatwillbeemphasizedinthisarticle.Thissocietyalsoincludedthe“extendedbasic”examinationthatincludestherightandleftventricularout-flowtracts(RVOTandL

3、VOT,respectively).ItisimportanttoincludeimagingthatdemonstratestherelationshipoftheLVOTandtheRVOTtodetectconotruncalabnormalities.美国超声医学协会（AIUM）和国际妇产科超声协会最近针对胎儿心脏超声检查出台了一项指南。国际妇产科超声协会指南包括了基于四腔心切面的最基本的心脏检查，其中重点强调了在此超声切面上的几个关键征象，同时指南还包括了“进一步”的检查，包括对左右心室流出道（RVOT和LVOT）的检查，明确两者的关系对于发现圆锥动脉干畸形非常重要。Depend

4、ingontechnicalfactors,suchasmaternalbodyhabitus,fetalage,orfetalposition,demonstratingtherelationshipoftheRVOTandtheLVOTmaybeproblematic.Alternativestoroutine2-dimensional(2-D)imagingofout-flowtractsincludetheuseof3-Dimagingtechnologiesincludingtheuseofdynamicmultiplanarimaging.Evenwithadvancedima

5、gingandtheabilitytoreconstructimagesindifferentplanes,theexaminermustbefamiliarwithroutinecardiacviewsorfailureofdetectionofCHDmaystilloccur.Thus,understandingbasiccardiacviewsisnecessarytodetectingCHDevenwithmoreadvancedimaging.Wewillconcentrateonamethodtobestunderstandthesebasicviews,suchasthe4-

6、chamberoroutflowtractviews,asaspringboardtomoreadvancedcardiacimaging.Analternativetotheseviewsisacomprehensiveexaminationofthefetalheart,whichmaybeobtainedusing4to5short-axisviewsoftheheart.These5planesinclude(1)thestomach;(2)the4-chamberviewoftheheart;(3)the5-chamberviewoftheheart;(4)thepulmonar

7、yartery(PA)bifurcation;and(5)thealignmentofthe3vessels,whicharethePA,aorta,andsuperiorvenacava(SVC).由于一些技术上的原因，比如母体的体质、胎龄或者胎儿体位等因素的影响，有时显示ROVT和LOVT的关系比较的困难。除了可以通过常规二维图像来显示流出道外，还可以应用三维影像技术包括使用多维动态图像技术来显示流出道。即便是具备了