| Part Ⅰ The value of echocardiography in the diagnosis of fetal congenital heart diseaseBackground and purpose:The incidence of congenital heart disease in fetus period, as much as 4%-10%, is one of the most common congenital malformations, As the main cause of neonatal death. Antenatal fetal ultrasound has a noninvasive, quick, clear display fetal heart and great vessels, the characteristics of structure and the hemodynamic changes. Screening abnormal heart can not only in the early detection of fetal cardiac structure, also can provide guidance for intrauterine or maternal interventions. But as a result of prenatal screening ultrasound fetal heart operation difficulty factor is higher and there is no a certain standard in clinical, lead to fetal prenatal diagnosis of congenital heart disease has been very low. And we pay more attention to the fetal heart heart structure deformation and connects to the heart artery malformation, tend to ignore the venous system, the missed diagnosis will be made in some diseases. Because of the development of fetal cardiac malformations in a process of evolution, and fetal hemodynamic state unlike after birth, cardiac malformation diagnosis does not necessarily exactly the same before and after birth. This topic discusses how to comprehensively and correctly survey for fetal malformation, avoid misdiagnosis and make reasonable explanation to the pregnant women, thus better supporting clinical, reduce the malformation fetus birth rate, reduce perinatal mortality, and provide a certain assistance for improving the population quality.Materials and methods:Survey 7020 cases of middle-late pregnant women by echocardiography, and divided into does not have tended to high-risk group and has a high risk group. Adding Pulmonary vein-atrial connection section, Seven-views order section method [On the transverse abdominal-the 4-chamber view-left, right ventricular outflow the edge(the crossed-relation of aorta and pulmonary artery view)-three-vessel-trachea view of the aorta-cut-ductus bow on cut surface-inferior vena cava cut surfacel was used in inspection. Tracking observation for screening of congenital heart disease. The fetus with congenial heart disease were autopsied after induced labor, compared with the results of ultrasound. For the continue to pregnancy, dynamic tracking fetal echocardiography every 4 weeks. Abnormal fetus will be checked by ultrasound within 24 hours after birth. On prenatal ultrasound found no abnormal fetal cardiac structure will be tracked every 8 weeks, until 6～12 months afterbirth. The evolution of the deformity and degree will be key of tracking, such as peak flow velocity and pressure within the narrow place. Results of Autopsy or angiography after birth or surgical will be contrast with ultrasound found. Evaluate the sensitivity and specificity and diagnostic accuracy of echocardiography; Compare incidence of fetal congenital heart disease between two groups. Collect the observation object detection rate of each section, compare various aspects show rate.Results:1. The check result of fetal congenital heart diseaseFollow-up finally confirmed 53 cases of cardiac vascular malformation, while prenatal detected 45 cases,8 cases misdiagnosis. Within 45 cases,43 cases were confirmed completely and 2 cases incomplete. Vascular malformation coincidence rate was 81.1%(43/53). In the induced labor of 35 cases, autopsy results are in conformity with ultrasonic diagnosis completely. Others were confirmed by angiography and surgery after birth,8 cases of full compliance with,2 cases of incomplete. The sensitivity of prenatal diagnosis of fetal congenital heart disease was 90%, while the Specificity was 100%.2. Compare between Pregnant women with high-risk group and no high-risk group in the incidence of congenital heart diseaseHave tendency of high-risk pregnant women had a significantly higher incidence of congenital heart disease is not pregnant women with high-risk tendency, P< 0.01).3, fetal heart rate of the standard section (%)Fetal four-chamber view, left, right ventricular outflow the edge, three-vessel-trachea view, long axis of the aortic arch section, pulmonary artery-ductus bow on cut surface and the inferior vena cava long axis view show rate were 98.95%,91.03%, 89.90%,91.03%,82.09%,81.96%,78.04%, according to four cavity heart rate is the highest, most of the observed objects can be successfully shows that the cross section, the lowest rate of inferior vena cava long axis cut surface, at 78.04%.Conclusion:1, Devided the conventional section, adding vein-atrium cut surface (including the inferior vena cava long axis view and the cut surface of left atrium and pulmonary vein connection) can detect pulmonary vein diseases and The superior or inferior vena cava ectopic drainage, while it greatly improve the rate of prenatal screening of complex CHD.2, Fully understand the dynamic evolution process of the development of fetal heart. With the growth of fetus and hemodynamic changes after birth, deformity of fetal cardiac may change, correct and objective explain to pregnant women is very important.3, Pregnancy middle-late each aspect overall display rate are higher, suggests that prenatal fetal cardiac ultrasound screening for fetal cardiac malformation is feasible.4, Prenatal echocardiographic has high sensitivity and specific degrees, It is the first detection tool in diagnosis congenital heart disease, with noninvasive and effective.oduced by Toshiba Aquilion ONE row 320 row CT. Scanning mode is volume. In Van Praagh order section diagnosis includes; atrial and ventricular septum and atrioventricular connection location, room area; Outside a large blood vessel connected parts andPart II Application of 320-row CT and Transthoradcechocardiography in diagnosis of complex congenital heart diseaseBackground and purpose:In the pediatric disease,congenital heart discese(CHD) is one of the most cause of death in children. It is estimated about 150?200 thousand Rewbom childres with CHD Bour country each year, and among Rem,ae complex CHD about 35%?38/and 60%?80 complex CHD children were death in critical con<Uio after birth.Depending accurate preoperative diagnosis, surgical or interve Rtional treatment can cure or relief these patients. With improvement and development in imaginge camination method,currently used pediatric heart disease mainly inclucle digital X echocardiograplty, DigUal tube imaging,MDCT and magnetic resoe ance ac.The thoracic echocardiography(TTE)is alwaysie preferred imaging exammatioe meaodie screening congenital heart Rsease. Wic CON stantly updated, CT equipment gradually become oie of ae maie means of screening. Through the analysis miss diagnosis of TTE and 320 row CT iespectively,This sudy wante explore how to use two kinds of iinaging methods correctly in preopeative diagnosis of congenital heart diseaseMaterials and methods:Retrospective analysis of 68 cases of patients wkh complex congenital heart disease, which contained the ultrasonic apprarance,320-row CT and surgical outcoming. Total 184 deformity were found in surgery. All of malformations were devited into three groups: intracardiac group, heart-large vascular connecting group and extracardiac group. Comparative three groups and a打alysis 也e miss diagnosis of TTE and 320 row CT respectively. Ultrasound examination including 2 d, M type,color doppler and spectral doppler ultrasound. CT check produced by Toshiba Aquilion ONE row 320 row CT. Scanning mode is volume. In Van Praagh order section diagnosis includes; atrial and ventricular septum and atrioventricular connection location, room area; Outside a large blood vessel connected parts andventricular great V的sels,巧〇.,and 3 d and 2 d 化splay and measurement.Results:184 malformations were comfirmed by surgery ic the 68 cases. Compare ie misdiagnosis and missed Aagnosis rate of CT and TTE: for the intracardiac anomalies we 12(11/93),1%(1/93) respectively(P<0.05), for the heart-large vascular connecting malformation was 4%(2/49), 6%(3/49) respectively(P >0.05),and for 化e extracardiac anomalies was 2/42),19/42) respaelively(P<0.05),for ie 1:otal anomalies was 8%。4/184),7% y 2/184) respectively(P >0.05). While it was (2/84) in diagnosis of total anomalies by boa CT and TTE.Conclusion:1,With high speed and good image quality and high detection rate,320 row CT can be used as a non-icvasive methods ic diagnosis of complex CON genital heart defects in young children or critically ill patients.2,Improve ultrasound scan skills and knowledge of rare diseases, which can effectively avoid the leakage of CON genital heart disease misdiagnosis.3,ultrasoiind and 320 row CT each have advantages, sometimes can complement each other. Combined use of ultrasound and 320 row CT can obviously improveie 81-3-11. |
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