Application Of Echocardiography In The Prenatal Diagnosis And Prognosis Of Fetal Atrial Septal Aneurysm

[Objective] To detect the new ultrasound signs of the fetal atrial septal aneurysm (FASA), echocardiography including TDE, PDE and CDFI, was performed in the study of the anatomy and hemodynamics of FASA. Ultrasound follow-up was made on atrial septal aneurysm (ASA) in the children who suffered FASA before birth. We expected to determine and evaluate objective indicators and prognosis of FASA.[Methods] FASA diagnostic criterions are atrial septal convexity＞6 mm, or occupy more than 25% of atrial diameter and ASA basal diameter≥6 mm.12 cases of FASA fetuses were selected as the study group and 30 fetuses of approximate gestational age and normal foramen ovale (FO) were selected as the control group. Observe TDE and CDFI ultrasound signs of the FO. The two groups were compared in the FO blood beam width and peak velocity, and the left and right atrium maximum pressure gradient. In the same period after childbirth, compare the study group and the control group in the FO closure rate and FO peak blood flow velocity and the left and right atrium maximum pressure gradient. Philips IE 33 and Siemens Sequoia 512 color Doppler ultrasonography instrument were used in the examinations. Philips IE 33 convex array scan probe C5-1, with the frequency of 1.0～5.0 MHZ, was used in prenatal examinations. Philips IE 33 fan array scan probe S8-3 of 3.0～8.0 MHZ and Siemens Sequoia 512 fan array scan probe 7V3C of 3.5～7.0 MHZ were used in afterbirth examinations. SPSS 17.0 software was used for data analysis. Chi-square (x2) test was used in sample rate comparison and t-test was used in sample mean comparison.[Results] There is significant discrepancy in fetal FO peak blood flow velocity and left and right atrium maximum pressure gradient between the FASA group and the control group.12 cases of FASA were all have aneurysm mass effect while mass effect wasn't detected in the control group. In the 12 cases of FASA fetuses, one with pulmonary hypertension, moderate to severe tricuspid regurgitation and severe pleural and abdominal effusion, termination pregnancy, adverse outcome of fetuses in the FASA accounted for 8.33%(1/12).The other 11 cases of term delivery had good recovery, ending well, accounting for 91.67% (11/12). At the end of the first month of postpartum, infants'FO closure rate of the two groups was statistically significant difference; FO blood flow peak velocity, left and right atrium maximum pressure gradient of the difference were not statistically significant. At the end of the 2nd to the 6th month of postpartum, there was no significant discrepancy between the two groups in FO closure rate, FO peak blood flow velocity and left and right atrium maximum pressure gradient.[Conclusion] Mass effect is specific signs of FASA in the four-chamber view of fetal heart. Color Doppler echocardiography is the best means of diagnosis of FASA. FASA alone is a short-term process of the development of some fetuses and should not be treated as malformation and terminated. FASA fetuses without complications have good outcome.