Bromley B, Estroff J A, Sanders S P, Parad R, Roberts D, Frigoletto F D, Benacerraf B R
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Am J Obstet Gynecol. 1992 May;166(5):1473-81. doi: 10.1016/0002-9378(92)91622-h.
Our objective was to assess the accuracy of prenatal echocardiography in detecting congenital heart defects in patients at high and low risk for structural cardiac anomalies.
Sixty-nine consecutive fetuses with congenital heart defects who had had prenatal ultrasonography at greater than or equal to 18 weeks' gestation were evaluated to determine the accuracy of prenatal ultrasonography in identifying structural cardiac defects. Thirty-nine patients were at high risk and 30 patients were at low risk for cardiac anomalies. All fetuses were scanned with standard four-chamber and outflow tract views. Data concerning extracardiac anomalies and karyotypic abnormalities were tabulated. The accuracy of the four-chamber view alone in identifying congenital heart defects was evaluated.
Fifty-seven of 69 fetuses (83%) were prenatally identified ultrasonographically as having a heart defect. There was no difference in the sensitivity of detecting cardiac anomalies between high-risk and low-risk groups. When the four-chamber view was used, only 63% of fetuses were recognized as having an abnormal heart. Extracardiac anomalies were noted in 36% and karyotypic abnormalities in 17% of patients.
The four-chamber and outflow tract views done routinely in an ultrasonography laboratory seeing a mixed population of patients was successful in detecting 83% of fetuses with structural cardiac malformations. Because 43% of the fetuses with heart defects were referred for low-risk indications, systematic ultrasonographic examination of the fetal heart should not be reserved only for those at high risk.
我们的目的是评估产前超声心动图在检测心脏结构异常高风险和低风险患者先天性心脏缺陷方面的准确性。
对69例妊娠18周及以上接受过产前超声检查的先天性心脏缺陷胎儿进行评估，以确定产前超声检查识别心脏结构缺陷的准确性。39例患者为心脏异常高风险，30例患者为低风险。所有胎儿均采用标准四腔心和流出道视图进行扫描。将有关心脏外异常和染色体核型异常的数据制成表格。评估仅四腔心视图识别先天性心脏缺陷的准确性。
69例胎儿中有57例（83%）在产前超声检查中被诊断为心脏缺陷。高风险组和低风险组在检测心脏异常的敏感性方面没有差异。仅使用四腔心视图时，只有63%的胎儿被识别为心脏异常。36%的患者存在心脏外异常，17%的患者存在染色体核型异常。
在超声检查实验室对混合人群进行常规的四腔心和流出道视图检查，成功检测出83%的有心脏结构畸形的胎儿。由于43%有心脏缺陷的胎儿因低风险指征而被转诊，因此胎儿心脏的系统性超声检查不应仅保留给高风险人群。
