| Objective:The fetal congenital heart disease has been taking the first place of severe birth defect in the world,there exists higher perinatal morbidity and mortality,and it is also the most easily missed congenital malformation in the prenatal ultrasound inspection.There are many types of aortic arc and its branch abnormality due to the larger variation of hemodynamics.The purpose of this study was to investigate the diagnostic value of prenatal ultrasound multi-section fetal heart screening in the diagnosis of abnormal fetal aortic arch and its branches.Method:Altogether 19,802 cases of second trimester(gestational age 22-26 weeks)fetuses screened by prenatal color Doppler ultrasonic system at our hospital within 5 years between January,2013 and December,2017 were collected in this study,among which there were 19,043 cases of single birth,375 cases of twins and 3 cases of triplets;the gestational ages were between 18 and 46 Y,the average age was 27.3±4.9 Y.Color Doppler ultrasound instruments such as GE E8,PHILIPS IU22 and MEDISON XG were utilized,normalized prenatal ultrasonic system screening was conducted by ultrasonic diagnosis physicians with prenatal system screening qualifications as per the requirements in the Prenatal Ultrasound and Pathological Anatomy Atlas of Fetal Malformation edited by Li Shengli.Choose fetal heart model,cross-section model more screening for fetal heart,check 72 cases of abnormal fetal aorta and its branches,follow-up the 72 cases of pregnant women pregnancy outcomes,summarize all kinds of ultrasonic image features and whether they are combined with intracardiac and intracardiac structural abnormalities,and analyze its detection rate,sensitivity,specificity,positive predictive value,negative predictive value,and an index and consistency check.Result:1.This study had correctly diagnosed 72 cases of fetal malformation of aortic arch and its branches,2 cases of missed diagnosis and 0 case of mal-diagnosis,its sensitivity,specificity,positive predictive value,negative predictive value,Yoden index and consistency were 97.3%,100%,100%,99.9%,97.3% and 99.9%,respectively.2.The incidence rate of aortic arch and branches malformation diagnosed by this study was 0.36%(72/19802),among which coarctation of aorta was 9.7%(7/72);interruption of aortic arch was 8.3%(6/72);right aortic arch,right arterial duct was 5.6%(4/72);persistent truncus arteriosus was 8.3%(6/72);right aortic arch complicated with aberration of left subclavian artery,left arterial duct was 47.2%(34/72);left aortic arch complicated with aberration of right subclavian artery,left arterial duct took up 14%(10/72);double aortic arch was 6.9%(5/72).3.Among the 72 cases of aortic arch and branches malformation detected in this study,there were 6 cases complicated with severe complex intracardiac structural abnormalities such as single atrium,single ventricle,double outlet of right ventricle,mitral atresia,tricuspid atresia etc.;6 cases were complicated with abnormality in other systems(6/72,8.3%),among which 2 cases(2/6,33.3%)were complicated with abnormalities in two systems(both of the two cases were complicated with cranial and digestive abnormalities),4 cases(4/6,66.7%)were complicated with one system abnormality(3 cases with facial abnormality and 1 case with reproductive system abnormality).4.Among 72 cases with abnormal aortic arch and its branches,60 cases were successfully followed up and 12 cases were lost to follow-up,with a follow-up rate of 83.33%.25 cases of induced labor,13 cases of induced labor specimens were obtained,and 13 cases were dissected with the assistance of pathologists.Among them,1 case of prenatal diagnosis of aortic arch disconnection was anatomically confirmed as severe narrowing of the main artery.Pathological anatomy and prenatal ultrasound screening were consistent with 12 cases,with a coincidence rate of 92.3%.The majority of the 35 newborns were diagnosed as fetuses with vascular ring by prenatal screening.The feeding,breathing and swallowing conditions were followed up.There were 27 cases without obvious clinical manifestations,7 cases with clinical symptoms and 1 case with premature death.Among them,1 case was diagnosed as double aortic arch "O" type vascular ring and right aortic arch and left subclavian artery vagus before and after the postpartum operation of left arterial catheter "U" type vascular ring.Conclusion:1.Prenatal ultrasound with multiple sections can effectively diagnose the abnormal aortic arch and its branches in fetuses with a detection rate as high as 97.3%,which has important clinical application value.2.All of the 72 cases of fetal malformations of aortic arch and its branches detected in these 5 years have typical ultrasonic image features,prenatal ultrasound aortic arch in a transverse section mode is more three-vessel-trachea view is the most effective section diagnosis of abnormal aorta and its branches,the long axis of the aorta,aortic arch section,aorta coronary section and cross section through tracheal bifurcation of oblique coronal plane is the key to the diagnosis and differential diagnosis of the aorta and its branches abnormal auxiliary plane.3.The abnormal part of the fetal aortic arch and its branches combined with other internal and external structural abnormalities,prenatal ultrasound imaging has important application value. |
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