Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China.
Department of Ultrasound, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China,
Fetal Diagn Ther. 2020;47(3):237-244. doi: 10.1159/000502182. Epub 2019 Sep 25.
Congenital disruptions of the hepatic vasculature such as hepatic vascular shunt and absence of ductus venosus (ADV) are rare and often asymptomatic. Moreover, hepatic vasculature abnormality, ADV, and umbilical shunt are easily missed during ultrasound screening due to insufficient scope of examination. In our study, we analyzed the associations among congenital hepatic shunt, ADV, and umbilical vein (UV) shunt by prenatal ultrasound screening.
This was a retrospective study of 9 cases of congenital hepatic vascular shunt and 14 cases of isolated ADV identified by prenatal ultrasound screening at Chengdu Women and Children's Center Hospital from 2014 to 2018. The review parameters included ultrasound findings of the fetal hepatic vessels, fetal heart, UV, other malformations, complications, and fetal prognosis.
The 9 cases of hepatic shunt included 6 cases of isolated portosystemic shunt, 2 mixed cases of vascular shunt with portosystemic shunt, and 1 case of intrahepatic arteriovenous fistula. Among the 8 total cases of portosystemic shunt, 5 were accompanied by ADV (62.5%). Of the 5 cases of congenital hepatic shunt with ADV, 3 were accompanied by umbilical shunt (60%). Among the 9 cases of hepatic vascular shunt, 6 were accompanied by dilated inferior vena cava and cardiomegaly (66.7%). Of the 19 total ADV cases identified, there were 14 cases without hepatic shunt, 5 with hepatic shunt, and 17 with umbilical shunt (89.4%). Among the 14 ADV cases without hepatic shunt, there were 5 cases with congenital heart defect (35.7%) and 4 with cardiomegaly (28.6%).
Portosystemic shunt, ADV, and umbilical shunt are closely associated. Appreciation of these associations can improve prenatal ultrasound screening for a timely prognosis and initiation of appropriate treatment.
肝血管先天性异常如肝血管分流和静脉导管缺如（ADV）较为罕见，且通常无症状。此外，由于检查范围有限，肝血管异常、ADV 和脐静脉分流在超声筛查中很容易被忽略。在本研究中，我们通过产前超声筛查分析了先天性肝分流、ADV 和脐静脉（UV）分流之间的关系。
这是一项回顾性研究，纳入了 2014 年至 2018 年在成都妇女儿童中心医院通过产前超声筛查发现的 9 例先天性肝血管分流和 14 例孤立性 ADV。回顾参数包括胎儿肝血管、胎儿心脏、UV、其他畸形、并发症和胎儿预后的超声表现。
9 例肝分流包括 6 例孤立性门腔分流，2 例血管分流伴门腔分流，1 例肝内动静脉瘘。在 8 例门腔分流中，5 例伴有 ADV（62.5%）。在 5 例伴有 ADV 的先天性肝分流中，3 例伴有脐分流（60%）。在 9 例肝血管分流中，6 例伴有下腔静脉扩张和心脏增大（66.7%）。在 19 例 ADV 中，有 14 例无肝分流，5 例有肝分流，17 例有脐分流（89.4%）。在 14 例无肝分流的 ADV 中，有 5 例伴有先天性心脏病（35.7%），4 例伴有心脏增大（28.6%）。
门腔分流、ADV 和脐静脉分流密切相关。了解这些关系可以提高产前超声筛查的准确性，及时预测并采取适当的治疗措施。
