抄録
最近, 重症先天性心疾患の出生前診断が児の予後を左右する重要な因子として認識されているため, 当院でも2000年10月から, 妊婦全例に対する胎児心臓スクリーニング検査を開始した。スクリーニング導入前の1996年1月〜1999年12月までに分娩した3,403例と, 導入後の2001年1月〜2004年6月までに分娩した2,726例のスクリーニング成績を比較した。導入前の重症先天性心疾患は8例で, 出生前診断は1例(12.5%), 出生後診断は7例(87.5%), 導入後は11例で, 出生前診断は8例(72.7%), 出生後診断は3例(27.3%)と, 導入前に比べ導入後は出生前診断率が大幅に上昇した。導入後の出生前診断8例中5例の異常検出断面は四腔断面で, 残り3例の異常検出断面は左右心室流出路であった。今後さらに出生前診断率をよくするには, 3vessel view の観察やカラードップラーによる四腔断面の観察, および妊娠後半期の再検が必要であると思われた。
Recently, it is recognized that prenatal diagnosis is a very important factor on neonatal management for severe congenital heart disease. For this purpose, fetal heart screening was started to examine all pregnant women since October 2000 in our hospital. We compared two groups : none-screened group of 3403 cases examined between January 1996 and December 1999, screened group of 2726 cases examined between January 2001 and June 2004. Eight cases of severe congenital heart disease were found in the none-screened group : one case (12.5 %) was diagnosed by fetal echocardiography, seven cases (87.5 %) were diagnosed after birth. On the other hand, eleven cases of severe congenital heart disease were found in the screened group : eight cases (72.7 %) were diagnosed by fetal echocardiography, three cases (27.3 %) were diagnosed after birth. Cases diagnosed by fetal echocardiography has increased considerably in the screened group. Five out of eight cases were diagnosed by screening of 4-chamber view, and three cases were diagnosed by screening of great arteries. We should add the observation of 3-vessel view, the observation of 4-chamber view with color doppler, and reexamination in the third trimester to increase the screening rate.
