| Objective Congenital heart disease occupies 1/3 of all birth defects, both incidence rate and mortality rate are the highest in fetal congenital malformations, right now is the primary noninfection mortality in the infant period. In spite of decreasing mortality of congenital heart disease infants, the incidence rate of congenital heart disease is still high.To prevent and control congenital heart disease infants, the application of high resolution ultrasonography to screen prenatal fetus is very important. This study aims to investigate the clinical application value of detecting fetal cardiac malformations by echocardiographic multiplane screening combing with color Doppler examinations.Methods 5218 pregnant women with single pregnancy were enrolled in this study, the fetuses were conducted with echocardiographic multiplane screening combing with color Doppler examinations. By using echocardiographic multiplane screening combing with color Doppler examinations, we observe heart location、size、modality 、 axis 、 mitral, tricuspid valve attachment and open close, integrity of interatrial septum and interventricular septum, foramen ovale and foramen valve activity, large blood vessels and heart conjunction, large vessels modality and encircling,abnormal echo and so on, using color Doppler to observe left and right ventricle blood flow direction,blood bundle width, interventricular septum,interatrial septum,each valve and large vessels blood flow. To the fetus suspect of tetralogy of Fallot, complete large vessel transposition, fatal cadiovascular malformations, if gravida agree to end gestation term,we seek the family agreement to conduct autopsy with fetus corpse for the result of heart. If refuse, we use echocardiographic to exam the fetus. To simple interatrial septum defect,interventricular septum defect, nonfatal cadiovascular malformations, we advise the gravida continue gestation, After labor, interventional operation and follow-up observation( some belongs to abnormal growth, not requiring intervention) are conducted to investigate.Infant heart malformation echocardiographic multiplied color examination is conducted by autopsy, interventional operation, follow-up observation(among it,some belong to abnormal growth, not requiring intervention) under the golden standard, in this way to evaluate ultrasonography prenatal screening clinic importance.Infants observed by echocradiogram to be normal in prenatal period will be investigated again 1 month after birth as routine follow-up investigation comparison,thus to avoid false-negative heart cardio graphic result. By using Chi-squared test to compare heart defect detection rate between solely applying two-dimensional ultrasound screening and assisting by color Doppler examinations; if P < 0.05, then judged as statistics difference exists.Results 99 cases were diagnosed as congenital structural heart disease by echocardiographic multiplane screening combing with color Doppler examinations during prenatal period, including 14 cases endocardial cushion defect,1 case combined with interatrial septum tumor like,12 cases single ventricle,7 cases simple interatrial septum defect or interventricular septum defect,7 cases double outlet right ventricle,2 cases downward displacement of tricuspid valve,5 cases tetralogy of Fallot,5 cases heart neoplasms,5 cases hypoplastic Left heart syndrome,3 cases permanent left superior vena cava,2 cases enlarged ventricle,2 cases complete great arteries transposition,2 cases of persistent truncus arteriosus,1 case right aortic arch,32 hyperechogenicity point inside heart.7 cases were missed diagnosis, including 2cases pure interatrial septum defect, 1 case interventricular septum effect, 1case interventricular septum defect, 1 case hypo plastic left heart syndrome, 1 case enlarged ventricle, 1 case neoplasms in the heart. By ultrasonography diagnosis conducted 1 month after infant birth, among it, pure interatrial septum defect, interventricular septum effect, interventricular septum defect can be identified and confirmed by interventional operation and follow-up investigation, while hypoplatic left heart syndrome and enlarged ventricle can be identified by autopsy after infant death. Neoplasms in the heart is normal in 22 gestational weeks,but is abnormal in 32 gestational weeks. According to postnatal clinic inspection,26 cases were diagnosed with strong points by prenatal echocardiogram inspection, with shrinking or largening, finally 73 cases were diagnosed with diseases. By solely using two-dimensional ultrasound screening, finally 57 cases were diagnosed, including 7cases endocardial cushion defect,12 cases single ventricle,2 cases simple interatrial septum defect or interventricular septum defect,7 cases double outlet right ventricle, 3cases tetralogy of Fallot,5 cases heart neoplasms,5 cases hypoplastic Left heart syndrome,3 cases permanent left superior vena cava,2 cases enlarged ventricle,2cases complete great arteries transposition,2 cases of persistent truncus arteriosus,1case right aortic arch, 6 cases hyperechogenicity point inside heart.Compared to solely using two-dimensional ultrasound screening, 12 more cases were diagnosed by using echocardiographic multiplane screening combing with color Doppler examinations; including 7 cases endocardial cushion defect, 4 cases simple interatrial septum defect or interventricular septum defect, 1 case downward displacement of tricuspid valve.Basing on data comparison of autopsy, interventional operation, follow-up investigation, and ultrasonic cardiogram taken 1 month after birth, it is proved that echocardiographic multiplane screening combing with color Doppler examinations plays an important role in identifying heart defect by multi-plane combined screening,with the study result as sensitivity reaching 91.3%, specificity reaching 99.5%, and accuracy reaching 90.8%. Use Chi-squared test to compare value difference of identifying heart defect between solely applying two-dimensional ultrasound screening and echocardiographic multiplane screening combing with color Doppler examinations.The result is Chi-squared test result reaches 6.61, and P < 0.05, then judged as statistics difference exists. Therefore we can figure out that echocardiographic multiplane screening combing with color Doppler examinations improves detecting rate of infant heart defect.Conclusion : The accuracy of echocardiographic multiplane screening combing with color Doppler examinations in identifying infant heart defect is comparatively high regarding clinical diagnoses, and assisting by color Doppler examinations will also improve detection rate of infant heart defect; which is of high clinical value for detecting heart defect during gestation period. |
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