| Objective: The purpose of this study was to explore the specific section and rapid screening method for the diagnosis of different types of vascular rings by fetal echocardiography,sum up fetal congenital vascular rings of different types.According to the diagnosis of different types of congenital vascular rings,according to the condition of tracheal compression evaluation of the prognosis.Methods: This study successfully acquired 1495 cases of fetal echocardiography,from 2016 January to 2017 March in Hebei province children's hospital,gestational age 22 to 26 weeks,average(24.02±1.22)week of gestation,pregnant women ages 20 to 30 years old,the average age(26.27 ±2.39).Follow up normal fetus and congenital vascular ring fetus,after line do echocardiography.The clinical symptoms of congenital vascular rings were observed in six months after birth.Prenatal stage,use American GE VOLSON series E8 Expert color Doppler ultrasonic tester for inspection,and then estimate ultrasonic gestational age,then in fetal heart examination.Observation of fetal abdominal transverse section,exclusion of other cardiovascular malformations,key observation three vessel trachea section and long axis of trachea.Cross examination of the fetal thorax,obtain standard four chamber view,use the method of lateral deflection of four chamber view [1],observation of three vessel trachea section(short axis section of trachea),then lock the trachea,rotating probe 90°,observe long axis view of trachea.Distinguish congenital vascular ring type in three vessel trachea section,clearly show the structure of the trachea and measured data.Measurement of the anterior and posterior diameters of fetal trachea with two wire method(DA-P)and the left and right diameter(DL-R),the notation of tracing pipe with manual,measured tracheal circumference(C),tracheal area(S)for statistical analysis.The abovedata are required to measure the same method three times,finally take the average of the data.Postpartum stage,collect information about the occurrence of tracheal or esophageal compression after birth,then use PHILIPS i E33 color Doppler ultrasound diagnostic system,Echocardiography was performed in neonates with congenital vascular rings and normal neonates.During the examination,the diagnosis was made by the three segment [2-4],further exclusion of cardiac and vascular malformations,and follow-up examination results of CT.Data were analyzed by statistical software SPSS 19.The data were compared with the normal group.Results: In this study,1420 cases of normal fetus;right aortic arch,left an arterial catheter 42 cases(27 cases of aberrant left subclavian artery,there is no aberrant left subclavian artery 15 cases);20 cases of double aortic arch(The right arch advantage 15 cases,the left arch advantage 4 cases,two arch is almost equal to the size of the 1 case);simple aberrant right subclavian artery 17 cases;pulmonary artery sling in 1 case? 1 The sonographic appearance of the three vessels and trachea in normal fetuses and different types of congenital vascular rings.In the three vessel trachea view,according to the arrangement of the aortic arch,pulmonary artery,and ductus arteriosus,you can determine whether the presence of vascular ring malformation.According to the different shape of the perivascular vessels,"C","U","O" surround can determine the type of vascular ring deformity.1.1 Normal fetal three vessel trachea view tracheal morphological rules,without deformation,a clear gap around the trachea,the tracheal diameter DA-P/DL-R?1.1.2 Left aortic arch,aberrant right subclavian artery in fetus show the tracheal morphological rules,round in shape,no obvious deformation,there are around the trachea gap,DA-P/DL-R?1.Tracheal circumference(C),tracheal area(S)comparison of tracheal data with normal group fetuses,there was no statistically significant difference(P>0.05).1.3 Right aortic arch and left ductus fetus show the tracheal morphological rules,oval or round like change,Comparison of anteroposterior diameter(DA-P)and normal fetal group,there was no statistically significant difference(P> 0.05).Tracheal diameter(DL-R)slightly smaller than the normal group,the difference was statistically significant(P<0.05),DA-P/DL-R?1.Tracheal circumference(C),tracheal area(S)data is smaller than normal fetal data,there was no statistically significant difference(P>0.05).There are around the trachea gap,some of the left and right gaps become smaller significantly.1.4 Double aortic arch fetus,three blood vessel trachea section showed irregular shape of trachea,there are clear deformation change,around the trachea gap was significantly smaller,some have almost disappeared,the boundary around the blood vessels and trachea is not clear.Anteroposterior diameter of trachea(DA-P),left and right diameter of trachea(DL-R),tracheal circumference(C),tracheal area(S)are less than the normal fetal tracheal data.The difference was statistically significant(P<0.05).1.5 Pulmonary artery sling is extremely rare,in the course of the study,only 1 cases of fetal pulmonary artery sling,the observation data of trachea,tracheal morphological changes,vascular encircles the trachea area around the gap significantly smaller.2 Ultrasound findings of normal and different types of congenital vascular rings in the long axis of fetal trachea.The long axis of the trachea in the normal fetus showed that the trachea was normal,no obvious enlargement or reduction,the fetus of Left aortic arch,aberrant right subclavian artery,the long axis of trachea showed that the morphology of trachea was consistent with that of normal fetus.Right aortic arch and left ductus fetus,the tracheal long axis view vascular encircles the trachea narrow site,nonvascular surrounding parts relative expansion.Double aortic arch fetus,tracheal long axis view: blood vessels around a part of trachea significantly smaller diameter,surround upper trachea normal or relative expansion.3 Postpartum outcome of children with vascular ring.Left aortic arch and right subclavian artery: a report of 17 cases,after birth without dyspnea and dysphagia symptoms;42 cases of right aortic arch and left ductus arteriosus,32 cases of smooth delivery,10 cases were lost.27 cases of neonatal echocardiography closed ductus arteriosus,there were 4 cases of closure of ductus arteriosus by echocardiography at the end of the last 3 months,1 cases of closure of ductus arteriosus during echocardiography at the end of 6 months.6 cases of prenatal fetal echocardiography highly suspected tracheal compression,postpartum CT examination,only 1 cases of children with tracheal compression,and repeated pulmonary infection sympt-oms,31 cases of children with no respiratory symptoms associated with tracheal compression;15 cases of double arterial arch fetus,5 cases of smooth delivery,the children have different degrees of tracheal compression related respiratory symptoms,all of 5 cases underwent echocardiography and CT examination,consistent with prenatal diagnosis,6 cases were diagnosed by prenatal diagnosis,4 cases of children lost;with pulmonary artery sling induced abortion.Conclusion: 1 Fetal echocardiography is very significant in the diagnosis of congenital vascular rings of advantage,is the most important means of inspection.Three vessel trachea view and long axis view of the trachea are an important part of the diagnosis and classification of congenital vascular diseases.2 Fetal echocardiography of the three vessel trachea view and long axis view of the trachea can clearly observe the changes of fetal tracheal morphology and clearance around the trachea,and the data were measured,whether or not the vascular ring produces pressure on the trachea and esophagus make accurate judgments,has a guiding value for the prognosis of congenital vascular ring assessment. |
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