1、刘子建香港中文大学妇产科学系胎儿心脏的正常和异常超声解剖Prenatal diagnosis of CHD先天性心脏病的产前诊断 Retrospective review 131,60 routine scan of low risk pregnancies Sensitivity: 9.25 only.Stoll C et al Prenat Diagn 19934 Chamber View四腔心4 chamber view: Sensitivity四腔心：敏感性 1022 high risk pregnancies: 92%Copel JA et al. AJOG 1987 3680 lo
2、w risk pregnancies: 81%Vergani P et al. AJOG 1992 5400 low risk pregnancies: 48%Achiron R et al BMJ 1992 15,281 low risk pregnancies: 16%Crane JP et al. AJOG 199429,035 fetuses1991-200135/82 major CHDs detectedon routine scan43%58 CHDs expected to have Abn 4-chamber views71%41/58 detected by Abn 4-c
3、hamber viewsTegnander heart left Axis- 45o 20o Size - 50% in diameter; 1/3 in area Ventricles - size, echogenicity Atria - size AV valve off-setting Ventricular septum - intact Pulmonary veins to left atrium Rhythm- regular Pericardial effusion? Position and axis位置和心轴 Levocardia: normal orientation
4、Dextrocardia: heart in R side of chest, apex pointing to the R Dextroposition: heart in R side of chest, apex pointing to the L Mesocardia: heart in mid-chest, apex pointing mid-line3 types of situs三种位置 Situs solitusNormal organ arrangementLiver on the R; Stomach on the L Situs inversusMirror-image
5、configurationLiver on the L; stomach on the R Situs ambiguousIndeterminate situsCardiac axis心轴Smith et al OG 1995Anatomy of the fetal heart- 4 chambers胎儿心脏解剖四腔心RVLVRALAAV off-setForamenOvaleTricuspidMitralAortaCardiac axisLeftRight4 chamber-heart sub-costal view四腔心-肋下观clip4 chamber-heart- apical view四腔心-心尖观clip4-chambers: colour flow四腔心-彩色血流clipFetal and probe positions胎儿和探头的位置Acoustic shadowSitus 位置clipPosition 位置Position 位置Position 位置DextropositionDextropositionPosition 位置Position位置
