臨床婦人科産科77巻11号

2023年11月発行

今月の臨床 胎児心臓を診る―この超音波所見を見逃すな！ 四腔断面異常から診断できる先天性心疾患

心房中隔欠損症・心室中隔欠損症・房室中隔欠損症

著者： 新谷光央¹

所属機関： ¹静岡県立こども病院周産期母子医療センター産科

ページ範囲：P.1074 - P.1091

●胎児心臓におけるmidline defectには，心房中隔欠損症（ASD），心室中隔欠損症（VSD），房室中隔欠損症（AVSD）の3疾患が挙げられるが，AVSD以外は胎児診断率が決して高いわけではなく，一次孔欠損以外のASDや漏斗部中隔のVSDの胎児診断は非常に困難である．

●左上大静脈からの血流によって拡張した冠静脈洞とASDの所見は，互いに誤認される可能性があるため，カラードプラにて血流方向を確認して判別するのがよい．

●VSDは必ずしも四腔断面で確認できるわけではなく，病型によって流出路を含む断面での評価が必要である．

●AVSDの胎児超音波検査の所見として，①scooping, ②三尖弁のoffsetがなく，収縮期に一直線状に並ぶ左右房室弁，③butterfly sign，④atrial-to-ventricular length ratio＞0.6などが挙げられる．

参考文献

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23）新谷光央，他 : 鹿児島県における先天性心疾患の発生率および出生前診断．鹿児島産婦会誌30 : 7-20, 2022