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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2021, Vol. 18 ›› Issue (08) : 721 -727. doi: 10.3877/cma.j.issn.1672-6448.2021.08.001

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房室间隔缺损胎儿期及出生后超声心动图的诊断及预后评估
耿斌1,†(), 李文秀1   
  1. 1. 100029　首都医科大学附属北京安贞医院小儿心脏中心超声科
  • 收稿日期:2021-04-20 出版日期:2021-08-01
  • 通信作者: 耿斌

Diagnosis and prognostic evaluation of atrioventricular septal defect by prenafetal and postnatal echocardiography

Bin Geng1(), Wenxiu Li1   

  • Received:2021-04-20 Published:2021-08-01
  • Corresponding author: Bin Geng
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耿斌, 李文秀. 房室间隔缺损胎儿期及出生后超声心动图的诊断及预后评估[J]. 中华医学超声杂志（电子版）, 2021, 18(08): 721-727.

Bin Geng, Wenxiu Li. Diagnosis and prognostic evaluation of atrioventricular septal defect by prenafetal and postnatal echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(08): 721-727.

图1 正常房室间隔解剖图。两条红线之间的部分为房室间隔，由肌部和膜部两部分组成，其中膜部间隔（MS）分为膜部间隔房室部（AV）及膜部间隔室间部（IV）
图4 流入道室间隔纵切面超声扫查示意图
表1 房室间隔缺损的分型及主要病理特征
分型 ASD VSD 房室瓣口 房室瓣异常 左侧房室瓣前叶与室间隔融合
完全型 + + 1个 共同房室瓣 -
部分型（包括过渡型）

部分型

 + - 2个 左侧房室瓣三叶化 +

过渡型

 + + 2个 左侧房室瓣三叶化 +
特殊类型（房间隔完整）

流入道VSD型

 - + 2个 左侧房室瓣三叶化 +

房间隔及室间隔完整型

 - - 2个 左侧房室瓣三叶化 +
图5 A型完全型AVSD产前超声心动图图像。图a为心尖四腔心切面显示舒张期左、右房室瓣融合为一个共同的房室瓣口及房室联合缺损（黄色线段所示）；图b为收缩期显示VSD（黄色线段所示）及原发孔型ASD（红色线段所示）；图c为彩色多普勒血流成像显示收缩期共同房室瓣可见大量反流信号（白色箭头所示）；图d为房室瓣口短轴切面显示左、右房室瓣融合为一个共同的房室瓣口及房室联合缺损（黄色线段所示），白色箭头所示为前桥瓣及下桥瓣，前桥瓣无明显骑跨，与右前上瓣交界处腱索附着于室间隔的嵴顶部；图e为流入道室间隔纵切面显示前桥瓣及下桥瓣在室间隔嵴顶部无融合（红色箭头示前桥瓣；黄色箭头示下桥瓣）；图f为彩色多普勒血流成像显示共同房室瓣左侧可见少量反流信号（黄色箭头所示）
图6 部分型AVSD产前超声心动图图像。图a为旁四腔心切面显示二尖瓣、三尖瓣根部在室间隔上附着点处于同一水平，房间隔原发孔回声缺失（红色箭头所示）；图b为彩色多普勒血流成像显示原发孔过隔血流信号（白色箭头所示）；图c为房室瓣口短轴切面显示舒张期二尖瓣前叶裂指向室间隔，使瓣口略呈三角形（红色箭头示三尖瓣；黄色箭头示二尖瓣）
图7 过渡型AVSD产前超声心动图图像。图a为后四腔心切面收缩期显示二尖瓣、三尖瓣处于同一水平，可见原发孔型ASD（黄色箭头指向的黄色线段所示）及VSD（红色箭头指向的红色线段所示）；图b为收缩期可见两个房室瓣口，红色线段所示为二尖瓣口，白色线段所示为三尖瓣口，并可显示原发孔缺损（黄色箭头指向的黄色线段所示）；图c为流入道室间隔纵切面显示二尖瓣前桥瓣（红色箭头所示）及下桥瓣（黄色箭头所示）在室间隔嵴顶部融合；图d为房室瓣口短轴切面显示舒张期两个房室瓣口（白色箭头所示）
图8 仅有VSD的AVSD超声心动图图像。图a为心尖四腔心切面显示二尖瓣、三尖瓣位于同一水平，可见VSD，房间隔连续完整；图b为彩色多普勒血流成像显示心室水平可见左向右分流信号（白色箭头所示），二尖瓣可见两束反流信号（黄色箭头所示）；图c 为大动脉短轴切面显示二尖瓣瓣叶裂指向室间隔；图d为剑下二尖瓣短轴切面显示二尖瓣前叶与室间隔粘连，即二尖瓣前叶裂，并可见VSD（黄色箭头所示）
图9 房间隔及室间隔完整的AVSD超声心动图图像。图a为心尖四腔心切面显示二尖瓣、三尖瓣位于同一水平，房间隔及室间隔连续完整；图b为彩色多普勒血流成像显示二尖瓣口可见两束反流信号（黄色箭头所示）；图c为大动脉短轴切面显示二尖瓣瓣叶裂（黄色箭头所示）指向室间隔；图d为彩色多普勒血流成像显示二尖瓣反流源于前叶裂（黄色箭头所示）
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