探讨胎儿永存左上腔静脉（PLSVC）合并肺/主动脉（PAD/AOD）及右/左心室（RVD/LVD）比例异常胎儿的产前超声特征及预后。

回顾性分析2016年1月至2019年12月重庆市妇幼保健院产前超声诊断为PLSVC合并无器质性改变的主动脉细及左心室小的胎儿（研究组）36例，以及相应孕周单纯PLSVC胎儿（对照组）83例的产前超声特征及随访结果，根据产前超声诊断的孕周将研究组胎儿分为中孕期研究组（21~27⁺⁶周，17例）及晚孕期研究组（28~39⁺⁶周，19例），相应孕周的对照组分为中孕期对照组（21~27⁺⁶周，61例）和晚孕期对照组（28~39⁺⁶周，22例），同时根据研究组胎儿不同妊娠结局将研究组进一步分为出生组及引产组，分析研究组及对照组胎儿超声心动图特点，采用t检验比较研究组、对照组及研究组内不同孕周、不同妊娠结局胎儿间RVD/LVD、主动脉瓣环Z-score（AOD_{（Z-score）}）以及PAD/AOD的差异，跟踪随访胎儿结局及生后发育情况。

36例合并主动脉细及左心室小的PLSVC胎儿与相应孕周的单纯PLSVC胎儿相比，其RVD/LVD（中孕期：1.45±0.26 vs 1.08±0.24，晚孕期：1.56±0.40 vs 1.10±0.20）和PAD/AOD（中孕期：1.81±0.45 vs 1.31±0.32，晚孕期：1.83±0.29 vs 1.32±0.30）值均增大，AOD_{（Z-score）}值减小（中孕期：-1.80±0.63 vs -0.36±0.11，晚孕期：-1.37±0.37 vs -0.06±0.29），差异均具有统计学意义（RVD/LVD：t=3.985，P=0.004；t=4.199，P＜0.001；PAD/AOD：t=-2.858，P=0.042；t=-3.142，P=0.006；AOD_{（Z-score）}：t=-3.362，P=0.016；t=-2.272，P=0.037）。研究组中，中孕期组结构数据95%可信区间：RVD/LVD为1.32~1.59，AOD_{（Z-score）}为-2.12~-1.47，PAD/AOD为1.58~2.04，晚孕期组结构数据95%可信区间：RVD/LVD为1.36~1.77，AOD_{（Z-score）}为-1.56~-1.18，PAD/AOD为1.68~1.98，同一孕期不同妊娠结局合并主动脉细及左心室小的PLSVC胎儿（出生组与引产组）心脏各结构数据比较，差异均无统计学意义（P均＞0.05）。随访结果显示，研究组与对照组胎儿出生后生长发育均无明显异常，合并主动脉细及左心室小的患儿37.03%（10/27）在出生后7 d内RVD/LVD恢复正常，88.23%（15/17）患儿出生后2年AOD恢复正常。

产前超声诊断为PLSVC合并不伴有器质性改变的主动脉细及左心室小的胎儿多为继发于PLSVC的主动脉细及左心室小，其心脏结构数据在一定范围内预后良好。

To explore the ultrasonic features and prognosis of fetal persistent left superior vena cava (PLSVC) combined with abnormal pulmonary artery diameter/aorta diameter (PAD/AOD) and right ventricle diameter/left ventricle diameter (RVD/LVD) ratios.

A retrospectively study was carried out on the ultrasonographic features and prognosis of fetuses from January 2016 to December 2019. Thirty-six fetuses with PLSVC combined with a narrow aorta and small left ventricle without other malformations (study group) and 83 fetuses with isolated PLSVC (control group) were included in this study. According to the gestation weeks when they were diagnosed at the first time, the fetuses were divided into four groups, namely, the study group in the second trimester (21~27⁺⁶weeks) (n=17), the study group in the third trimester (28~39⁺⁶weeks) (n=19), the control group in the second trimester (n=61), and the control group in the third trimester (n=22). At the same time, fetuses in the study group were further divided into either a labor group or an induced labor group according to the pregnancy outcome. The parameters of cardiac structure were measured, and the RVD/LVD ratio, PAD/AOD ratio, and Z-score of aorta diameter (AOD) were calculated. All the parameters in the study group were compared within groups or with those of the control group. After homogeneity of variance was verified, the data were statistically analyzed by t test and non-parametric test. Outcome of the fetuses and postnatal developmental state were followed.

Compared to the control group with isolated PLSVC, the ratios of RVD/LVD (second trimester: 1.45±0.26 vs 1.08±0.24; third trimester: 1.56±0.397 vs 1.10±0.20) and PAD/AOD (second trimester: 1.81±0.45 vs 1.31±0.32; third trimester: 1.83±0.292 vs 1.32±0.30) were significantly larger, while AOD_(z-score) (second trimester: -1.80±0.63 vs -0.36±0.11; third trimester: -1.37±0.37 vs -0.06±0.29) was smaller; the differences were statistically significant (RVD/LVD: t=3.985, P=0.004; t=4.199, P＜0.001; PAD/AOD: t=-2.858, P=0.042; t=-3.142, P=0.006; AOD_(Z-score): t=-3.362, P=0.016; t=-2.272, P=0.037). For the study group in the second trimester, the 95% confidence intervals (CIs) of the structure data were: RVD/LVD: 1.32 to 1.59; AOD _(Z-score): -2.12 to -1.47; PAD/AOD: 1.58 to 2.04. For the study group in the third trimester, RVD/LVD ranged from 1.36 to 1.77, AOD_(Z-score) ranged from -1.56 to -1.18, and PAD/AOD ranged from 1.68 to 1.98. There was no significant difference in the structure data or outcomes in the PLSVC fetuses combined with abnormal PAD/AOD and RVD/LVD ratios in the same gestational weeks (P＞0.05). Follow-up results revealed that the growth and development of all the fetuses seemed normal. In the study group, the RVD/LVD ratio returned to normal in about 37.03% (10/27) of newborns in 7 days after birth. Aorta diameter returned to normal in 88.23% (15/17) of babies in 2 years after birth.

Fetuses diagnosed with PLSVC combined with a small aorta and left ventricle without structural changes mostly have the secondary changes of isolated PLSVC. They have a favorable prognosis when the parameters of cardiac structure are within some limits.