Volpe P, Campobasso G, De Robertis V, Di Paolo S, Caruso G, Stanziano A, Volpe N, Gentile M
Department of Obstetrics and Gynecology, Hospital Di Venere, Bari, Italy.
Ultrasound Obstet Gynecol. 2007 Nov;30(6):830-7. doi: 10.1002/uog.5145.
To explore whether the use of four dimensional (4D) ultrasound examination with B-flow imaging and spatiotemporal image correlation (STIC) can supply additional information with respect to two-dimensional (2D) gray-scale and color Doppler echocardiography in the prenatal characterization of isolated total anomalous pulmonary venous connection (TAPVC).
The study population comprised a group of three TAPVC fetuses that had been examined exclusively by conventional echocardiography, and a group of four additional cases initially identified by conventional echocardiography and examined further by 4D ultrasonography; a thorough postnatal work-up was available for all fetuses.
At our center, isolated TAPVC was found in seven of 1040 fetuses with cardiac defects (0.67%). Anomalous drainage was supracardiac to the innominate vein in three cases, cardiac to the coronary sinus in two, and infracardiac to the portal vein in the remaining two cases. An evident asymmetry between left heart and right heart structures was observed in 4/7 cases. The confluence of the anomalous pulmonary veins (PVs) was visualized in 4/7 cases and the connecting vertical vein was identified in 3/5 cases at 2D echocardiography. 4D ultrasound imaging with B-flow imaging and STIC clearly visualized the anomalous PV confluence and the draining vertical vein in all four cases examined.
2D and color Doppler echocardiography appears to diagnose reliably TAPVC, albeit with some limitations in thorough assessment of the pathology, depending on the anatomy of the defect, on the technical adequacy of the equipment used and on the experience of the operator. 4D ultrasound examination with B-flow imaging and STIC is apparently able to facilitate identification of the anatomical features of TAPVC, thus supplying additional information over that provided by 2D fetal sonography.
探讨使用带有B-flow成像和时空图像相关技术（STIC）的四维（4D）超声检查，相对于二维（2D）灰阶和彩色多普勒超声心动图，能否在产前孤立性完全性肺静脉异位连接（TAPVC）的特征描述方面提供更多信息。
研究人群包括一组仅通过传统超声心动图检查的3例TAPVC胎儿，以及另一组最初通过传统超声心动图检查并进一步接受4D超声检查的4例额外病例；所有胎儿均有完整的产后检查结果。
在我们中心，1040例有心脏缺陷的胎儿中有7例发现孤立性TAPVC（0.67%）。3例为心上型经无名静脉引流，2例为心内型经冠状静脉窦引流，其余2例为心下型经门静脉引流。4/7例观察到左心和右心结构明显不对称。二维超声心动图检查时，4/7例可见异常肺静脉汇合，3/5例可识别连接垂直静脉。在所有接受检查的4例中，带有B-flow成像和STIC的4D超声成像清晰显示了异常肺静脉汇合和引流垂直静脉。
二维和彩色多普勒超声心动图似乎能够可靠地诊断TAPVC，尽管在全面评估病变时存在一些局限性，这取决于缺损的解剖结构、所用设备的技术适用性以及操作者的经验。带有B-flow成像和STIC的4D超声检查显然能够促进TAPVC解剖特征的识别，从而提供比二维胎儿超声检查更多的信息。
