【摘要】 目的 总结胎儿冠状动脉-右房瘘（CA-RAF）的超声心动图特征。方法 选取我院经产前超声心动图诊断为孤立性CA-RAF胎儿13例，分析其瘘管起源、走行、瘘入部位等声像图特征，并对其进行随访，比较胎儿出生前、后冠状动脉主干近端内径、瘘管最宽处内径、瘘口内径及瘘口峰值流速的差异。结果 13例CA-RAF胎儿出生前超声心动图均显示扩张的冠状动脉起源于冠状动脉主干近端，呈现特征性走行，最终瘘入右房；扩张瘘管内及右房瘘口处均可探及异常高速湍流信号。13例病例中，10例于出生后经超声心动图或CT血管成像确诊（其中3例接受手术治疗，7例持续观察），2例引产后经尸检证实，1例失访。出生后超声心动图随访显示，冠状动脉主干近端内径由出生前的（2.08±0.58）mm增加至（4.69±2.05）mm，瘘口内径由（1.64±0.55）mm增大至（2.42±0.84）mm，瘘口峰值流速由（1.83±0.64）m/s增快至（3.61±0.72）m/s，瘘管最宽处内径由（2.44±0.99）mm增宽至（5.26±3.41）mm，出生前、后上述各参数比较差异均有统计学意义（均P<0.05）。结论 胎儿CA-RAF超声心动图表现具有特征性，可为其预后评估及出生后早期干预提供重要的指导意义。更多还原

【Abstract】 Objective To summarize the echocardiographic characteristics of fetal coronary artery-right atrial fistula(CA-RAF).Methods A total of 13 fetuses diagnosed with isolated CA-RAF by prenatal echocardiography in our hospital were enrolled.Echocardiographic features,including fistula origin,course,and drainage site,were analyzed.Follow-up was performed to compare differences in the proximal diameter of the main coronary artery,maximum diameter of the fistula,fistula orifice size,and flow velocity before and after birth.Results Prenatal echocardiography in all 13 CA-RAF fetuses showed dilated coronary arteries originating from the proximal segment of the main coronary artery,exhibiting a characteristic course and ultimately draining into the right atrium.Abnormal high-velocity turbulent signals were detected in the dilated fistula and the fistula orifice of right atrium.Among the 13 cases,10 were confirmed by postnatal echocardiography or CT angiography(3 underwent surgical treatment,7 were under continuous observation),2 were confirmed by autopsy after termination of pregnancy,and 1 was lost to follow-up.Postnatal echocardiographic follow-up revealed that the proximal diameter of the main coronary artery increased from(2.08±0.58)mm prenatally to(4.69±2.05)mm postnatally,the fistula orifice diameter increased from(1.64±0.55)mm to(2.42±0.84)mm,and the peak flow velocity at the fistula orifice increased from(1.83±0.64)m/s to(3.61±0.72)m/s.The maximum diameter of the fistula widened from(2.44±0.99)mm prenatally to(5.26±3.41)mm postnatally. All parameters showed statistically significant differences between prenatal and postnatal parameters(all P<0.05).Conclusion Fetal CA-RAF exhibits distinct changes in echocardiographic characteristics.Prenatal echocardiographic diagnosis provides significant guidance for prognosis assessment and early postnatal intervention.更多还原