Brook M M, Silverman N H, Villegas M
Department of Pediatrics, UCSF School of Medicine 94143-0214.
West J Med. 1993 Sep;159(3):286-300.
Fetal cardiac ultrasonography has become an important tool in the evaluation of fetuses at risk for cardiac anomalies. It can both guide prenatal treatment and assist the management and timing of delivery. We recommend that a fetal echocardiogram be done when there is a family history of congenital heart disease; maternal disease that may affect the fetus; a history of maternal drug use, either therapeutic or illegal; evidence of other fetal abnormalities; or evidence of fetal hydrops. The optimal timing of evaluation is 18 to 22 weeks' gestation. An entire range of structural cardiac defects can be visualized prenatally, including atrioventricular septal defect, ventricular septal defect, cardiomyopathy, ventricular outlet obstruction, and complex cardiac defects. The outcome for a fetus with a recognized abnormality is unfavourable, with less than 50% surviving the neonatal period. Fetal cardiac arrhythmias are also a common occurrence, 15% in the series described here. Premature atrial or ventricular contractions are most commonly seen and usually require no treatment. Supraventricular tachycardia can result in hydrops and require in utero treatment to prevent fetal demise. Complete heart block, particularly in association with structural heart disease, has a poor prognosis for fetal survival.
胎儿心脏超声检查已成为评估有心脏异常风险胎儿的重要工具。它既可以指导产前治疗，又有助于分娩的管理和时机选择。我们建议，当存在先天性心脏病家族史、可能影响胎儿的母体疾病、母体有治疗性或非法药物使用史、其他胎儿异常证据或胎儿水肿证据时，应进行胎儿超声心动图检查。最佳评估时机是妊娠18至22周。产前可以看到一系列结构性心脏缺陷，包括房室间隔缺损、室间隔缺损、心肌病、心室流出道梗阻和复杂心脏缺陷。已确诊异常的胎儿预后不佳，新生儿期存活率不到50%。胎儿心律失常也很常见，在此系列研究中占15%。最常见的是房性或室性早搏，通常无需治疗。室上性心动过速可导致水肿，需要宫内治疗以防止胎儿死亡。完全性心脏传导阻滞，尤其是与结构性心脏病相关时，胎儿存活预后不良。
