稲村 昇

Noboru INAMURA

近畿大学医学部小児科学教室

Department of Pediatrics, Kindai University Faculty of Medicine

キーワード : congenital heart disease, fetal diagnosis, fetal echocardiography

近年，先天性心疾患（CHD）に対する胎児心エコー検査は日常診療の一部となった．CHDの胎児診断はスクリーニングと精査に分かれる．両者ともに観察範囲に違いがあるものの，左右の確認，腹部断面，四腔断面，左右流出路，three-vessel view，three-vessel trachea view，大動脈弓と基本断面を順次描出し，スクリーニングや確定診断を行う．基本断面の描出方法には基本的なスキルが要求されるが，大動脈弓の描出には高度なスキルが必要である．次に，基本断面からどのような基準で正常と異常を区別すればいいのか悩むことがある．特にスクリーニングにはある程度の尺度が必要である．CHDには染色体異常や心外異常を合併することがあり，心外異常を評価することで診断精度を向上できる．最後に基本断面を精査するうえで陥りやすいピットホールが存在する．このため心室中隔欠損などは擬陽性が多くなりがちである．本論文では現在の診断方法で確認する範囲を明確にし，追加することで検出率が向上する裏技について解説する．

In recent years, fetal echocardiography for congenital heart disease (CHD) has become a part of routine medical care. Fetal echocardiography for CHD is divided into screening and scrutiny. Although the two differ in terms of the observation range, they both check the left and right sides and visualize the abdominal cross section, the four-chamber view, the left and right outflow tracts, the three-vessel view, the three-vessel trachea view, the aortic arch, and the basic cross section, respectively performing screening and scrutiny (definitive diagnosis). While basic techniques are required for visualization of the basic cross section, advanced techniques are required for that of the aortic arch. Moreover, there are no clear criteria to distinguish normal and abnormal from the basic cross section. In particular, screening requires some judgment criteria. CHD can be complicated by chromosomal abnormalities and exocardiac disorders. The diagnostic accuracy can be improved by evaluating exocardiac disorders. Last, the scrutiny of basic cross sections has some pitfalls into which we may fall. For this reason, ventricular septal defects and so on tend to give false positives. This paper clarifies the range to be checked by the current diagnostic method and provides some tips to improve the detection rate by making additions to the established methodology.