產前診斷胎兒雙主動脈弓血管環

胎兒心臟超音波已成為產前診斷先天性心臟病的利器，血管環因無明顯的前趨症，在嬰幼兒早期不易診斷，但卻有致命的危險，在胎兒早期發現血環更是少見，在此我們提出一病例為雙主動脈弓血管環合併右心室雙出口症，在懷孕25週，經由胎兒心臟超音波早期診斷。在出生後一個月，因開始出現氣道壓迫及吞食困難，而接受外科血管分離術。術後因支氣管軟化而接受支氣管支架置放而解決呼吸窘迫情形。胎兒心臟超音波檢查，是產前診斷先天性心血管異常的利器，藉由早期診斷，早期治療，將可減少術後罹病率及併發症。
Fetal echocardiography is feasible and effective for the prenatal diagnosis of congenital heart disease. Even though a vascular ring is potentially lethal, it can be difficult to diagnose in early infancy because symptoms may be absent or non-specific. We report a vascular ring with a double aortic arch (DAA) associated with a double outlet right ventricle (DORV) that was diagnosed in a male fetus at 25 weeks gestational age. Tracheal compression was noted at 36 weeks. After delivery at 39 weeks, the patient gradually developed respiratory distress and mild dysphagia with postprandial vomiting. At age one month, the double arch was surgically divided. Postoperative tracheomalacia was present. After 6 months of supportive care, biventricular total correction of the DORV was performed and a tracheal stent was implanted. Relief of respiratory distress followed. Early fetal diagnosis of vascular rings will reduce preoperative and postoperative morbidity and mortality.