The Clinic Value Of Prenatal Ultrasonography In The Diagnosis Of Congenital Heart Disease

Congenital cardiovascular disease is refers to the cardiovascular system grows unusualin the embryonic period during cardiovascular development,dueing to a variety ofpathogenic factors,when they are born there is a cardiovascular structural malformations and(or) function abnormal disease.Our country is one of the countries with a high incidence ofbirth deficiencies. Congenital cardiovascular disease is one of the most commoncategory.Making immediate diagnosis and giving treatment timely has the great significanceto improve population quality in pregnancy.Antenatal examination mainly includingultrasound diagnosis,pregnant women serological examination estimating the risk ofchromosome abnormality rates,amniotic cavity puncture,chorion biopsy to get fetal cellsused to analysis fetal karyotype,virus immunology examination,amniotic fluid biochemicalexamination,at present the ultrasound diagnosis is the only noninvasive diagnosis method forscreening deformity in pregnancy,but also has the high accuracy rate,repeatability,etc.Inrecent years,ultrasonic diagnosis technology has developed rapidly,with the progress of theultrasonic imaging and mixing together many subjects, prenatal ultrasonographic diagnosisrate is more and more high,clinical application value is more and more big,which is widelyaccepted by people.Three-dimensional and four-dimensional echocardiogram has graduallybecome the important means to diagnose congenital cardioascular disease at present.Objective: Through various ultrasonic features of congenital heart disease,and analyzingthe incidence of congenital cardioascular disease,high risk factor,other systemmalformation and chromosome abnormality,to explore the clinic value of prenatalultrasonography in the diagnosis of congenital heart disease.Method: Retrospected4200pregnant women’s prenatal ultrasonographic examinationresults of China-Japan Union Hospital and the First Hospital of jilin university in October2009to February2012.Pregnant women aged from18to42years old,and the average agewas30years old.Gestational age was from18to40weeks,and the average was29weeks.Regular prenatal ultrasonographic examinated the fetal each system, including thehead and brain structure,face ministry structure, neck, spine, heart, viscera of thoracic cavity and abdominal cavity, limbs forms,and measured fetal double top diameter,headcircumference,abdominal circumference, length of femoral and humerus,Amniotic FluidIndex and measured blood flow parameters of umbilical artery,to evaluate fetal growth andfetal weight by equipment automaticly.The Key to get fetal cardiovascular system ultrasoundexamination,selected the the heart examination procedures of ultrasonic instruments,firstlyprobe crosscut fetal abdominal standard to get4chamber view (4CV),and then rotated andmoved the scanning probe to get left and right ventricular outflow view(VOTV), threevascular view (3VV), three vessels-tracheal view (3VVT), and the aortic arch and arterycatheter arch view,superior and inferior vena cava views to observe carefully fetal heartcondition, and connecting with the color doppler flow imaging to test specific vascularhemodynamic changes, including blood flow velocity, direction, etc. Only were fivepregnant women diagnosised of congenital cardioascular disease were agreeed to be took20ml amniotic fluid to our research center by the method of FISH do karyotype analysis,testing13,18,21,22four kinds of chromosome anomalies.4200cases of basic material andultrasound examination results of ultrasound diagnosis the fetus cardioascular anomalieswere summarized to analyze the incidence of cardiovascular system malformation fetus, riskfactors, the relationship with other system malformation and chromosome abnormality,andultrasonographic features of fetal cardioascular anomalies. And prenatal ultrasonographicdiagnosis fetal cardioascular anomalies of the pregnant women were follow-up finally toconfirmed prenatal ultrasonographic diagnosis accuracy.Results:4200cases were detected in fetal cardiovascular system malformation fetus26cases（not include ASD）, fetal malformation rates of cardiovascular system for6.19‰(26/4200).It is one of the most common congenital defect, including VSD9cases, AVSD4cases (1case with TGA),TOF4cases (1case with artery catheter absent), singleventricle3cases (1case with single atrium), persistent left superior vena cava2cases(1casewith right superior vena cava absent), PTA1case,complete transposition of the greatarteries1case, vascular rings1case,DORV with VSD1case.At18to24weeks ofultrasonic diagnosis detection rate was57.69％.4CV diagnosis rate was34.62％,4CVtogether with VOTV diagnosis rate76.92％,and with3VVT diagnosis rate was100％.11pregnant women have risk factors, who are more than35years old and have a adversepregnancy history have a statistical significance with the incidence of cardioascular abnormalities fetus,and together with other system malformation in10cases, mainlyincluding the nervous system malformation and urinary system malformation, etc.4fetalwho were diagnosed congenital heart disease were confirmed by autopsy after odinopoeia，5fetal were only odinopoeia not to autopsy（3case were follow-up by telephone），13fetalwere confirmed by heart ultrasound when he was born a month later.（4case were follow-upby telephone）.One example VSD did a ventricular septal defect suture in postpartum1year.4cases were lost to follow-up.Through the follow-up results can be confirmed theaccuracy of the prenatal ultrasonographic diagnosis were17cases,Coincidence rate was65.38%. Five cases of cardiovascular system malformation fetus amniotic fluid test resultsshow that it is combined with the chromosome abnormality in2cases, with21-three body1case, and22q11.2loss1case.Conclusions:①Prenatal ultrasonographic diagnosis is a simple,safenoninvasive,repeatable antenatal examination method,is accepted by the pregnantwoman,clinical diagnosis of fetus cardiovascular system malformation has a higher accuracy.②Most of the cardiovascular system malformation has a typical ultrasound performance,can be clear diagnosed in pregnancy.The four-chamber view is the most basic ultrasoundview which can eliminate most of cardioascular anomalies, but it needs to be combined withother views to prevent misdiagnosis. The highest diagnosis Gestational age is from18to24weeks, and pregnant women should check again to increase diagnosis rate and reduce themissed diagnosis at late pregnancy.③Fetal cardioascular anomalies is one of the mostcommon birth defects, the age of whom are more than35years old and have a adversepregnancy history have correlation with the incidence of fetal congenital heart disease.Fetalcongenital cardioascular disease is always associated with other system malformation andchromosome abnormality, and the most common are urinary system malformation anddigestive system,21-three body and22q11.2micro loss syndrome are related to fetalcongenital cardioascular disease.It is suspected of cardiovascular system malformation of thepregnant women that you should pay attention to other organs in the scanning, preventingwith other deformity, and connecting with the chromosome screening for further cleardiagnosis.④Combine ultrasound imaging with chromosome detection results, we can definethe diagnosis of fetal cardiovascular system malformation, and in the genetic consultationhad a clear advice to merge chromosome abnormality of cardiovascular system malformation fetus can terminate gestation as early as possible, no chromosome abnormality and slightdeformity of the fetus can get early treatment, so as to achieve the target that early diagnosisand early intervention, reduce birth defects, improve the quality of the population.