【作者】 赵胜；

【导师】 邓又斌；

【作者基本信息】 华中科技大学 ， 影像医学与核医学， 2011， 博士

【摘要】 目的探讨二维应变成像在评价双胎输血综合征(twin-twin transfusion syndrome, TTTS)受血儿右心功能中的价值。方法选择TTTS 16例及正常单绒毛膜囊双羊膜囊双胎19例,分别测量两个胎儿脐动脉、脐静脉、静脉导管、大脑中动脉、房室瓣口、半月瓣口等部位的血流频谱参数,计算心肌做功指数。然后局部放大胎儿四腔心,清晰显示心内膜及肌层,动态存储2~3个心动周期,脱机分析两组胎儿右心纵向收缩期峰值应变。结果(1)TTTS受血儿心胸面积比值、右心心肌做功指数大于供血儿及对照组,差异有显著性意义。(2)TTTS受血儿右心游离壁、室间隔及平均纵向收缩期峰值应变小于供血儿及对照组,差异有显著性意义。结论二维应变成像可反映TTTS受血儿的右心心肌运动异常,但是在羊水过多及胎动频繁时应用受到限制。目的探讨彩色多普勒超声在评价双胎输血综合征受血儿心功能中的价值。方法选择TTTS 17例,孕龄为16.4~29.2周,平均(23.2±3.4)周。常规测量胎儿双顶径、头围、腹围及股骨长;系统扫查胎儿全身结构;测量胎儿脐动脉、脐静脉、静脉导管、大脑中动脉等血流参数;测量胎儿心胸面积比值及房室瓣、半月瓣的血流参数,计算心肌做功指数。结果(1)受血儿体质量、心胸面积比值、右心心肌做功指数均明显大于供血儿,差异有统计学意义(P<0.05)。(2)受血儿脐静脉频谱异常、静脉导管频谱异常、三尖瓣舒张期血流频谱异常、三尖瓣反流均明显多于供血儿,差异有统计学意义(P<0.05)。(3)受血儿中2例发生右室流出道梗阻,分别为Ⅲ级和Ⅳ级。结论彩色多普勒超声可敏感反映TTTS受血儿心功能特别是舒张功能的异常,为判断病变的严重程度提供重要的临床信息。目的探讨二维及彩色多普勒超声在评价双胎输血综合征(TTTS)供血儿心功能中的临床价值。方法选择TTTS 17例及正常单绒毛膜囊双羊膜囊双胎19例,测量脐动脉、脐静脉、静脉导管等血流频谱参数,计算心胸面积比值及心肌做功指数,重点分析供血儿的心功能改变。结果TTTS供血儿中7例出现脐动脉舒张期血流缺失或反向,1例发现心脏明显扩大并合并心包积液。供血儿静脉导管搏动指数明显高于对照组胎儿。结论TTTS供血儿已出现一定程度的心功能异常,动态监测心功能状况有助于判断TTTS的严重程度和干预治疗的疗效。更多还原

【Abstract】 Objective To evaluate the value of two-dimensional strain imaging in assessing right ventricular function of recipient fetus in TTTS pregnancies.Methods This study included 16 TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls). Doppler studies of the umbilical artery, umbilical vein, ductus venosus, middle cerebral artery, atrioventricular valve and semilunar value were recorded in both fetus, and myocardial performance index of both ventricles was calculated. Longitudinal peak systolic strain of right ventricular were calculated and compared between recipient fetus and other fetus.Results (1) Cardiothoracic ratio and myocardial performance index of right ventricular showed significant differences between recipient fetus and controls. (2) Right ventricular strain was decreased in recipient fetus compared with controls.Conclusions Two-dimensional strain imaging can be uesed to evaluate right ventricular myocardial function in the recipient fetus of TTTS. Objective To evaluate the value of color Doppler in assessing cardiac function of recipient twin in twin-twin transfusion syndrome (TTTS) pregnancies.Methods This study included 17 TTTS pregnancies. Doppler studies of the umbilical artery, umbilical vein, ductus venosus, middle cerebral artery, atrioventricular valve and semilunar value were recorded in both fetus, and cardiothoracic ratio, heart rate, myocardial performance index of both ventricles were calculated.Results (1)The estimated fetal weight, Cardiothoracic ratio, myocardial performance index of right ventricle in recipient twins were significant higher than that of donor twin. (2)The incidence of abnomal Doppler findings in umbilical vein, ductus venosus and tricuspid valve of recipient twin were all significantly higher than that of donor twin. (3)There were two recipient twin manifesting right ventricular outflow tract obstruction in this study.Conclusions Color Doppler imaging can be used to evaluate cardiac dysfunction in the recipient twin. Objective To evaluate the value of 2D and color Doppler ultrasonography in assessing cardiac function of donor fetus in twin-twin transfusion syndrome (TTTS) pregnancies.Methods 17 TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls) were including in this study. To observe the cardiac funtion of donor fetus, Doppler patterns of the umbilical artery, umbilical vein, ductus venosus and myocardial performance index of both ventricles were assessed in all fetus.Results Absent or reversed diastolic blood flow in umbilical artery were found in 7 donor fetus. One donor fetus showed increased cardiothoracic ratio and pericardial effusion. Pulsatility index of the ductus venosus in donor fetus were significant higher than that of controls.Conclusions Mild cardiovascular abnormalities were found in donor fetus, and follow-up examination were helpful in assess the severity of this disease.更多还原