๐Ÿซ€ Why Do We Need to Check Pulmonary Veins in Fetal Ultrasound?

ํ์ •๋งฅ์€

โ€œ์‚ฐ์†Œ๊ฐ€ ๋Œ์•„์˜ค๋Š” ๊ธธโ€์ž…๋‹ˆ๋‹ค.

์ฆ‰,

  • ํ๋™๋งฅ์€ ๋‚˜๊ฐ€๋Š” ๊ธธ
  • ํ์ •๋งฅ์€ ๋Œ์•„์˜ค๋Š” ๊ธธ

๋‘˜ ๋‹ค ๋ด์•ผ circulation์ด ์™„์„ฑ๋ฉ๋‹ˆ๋‹ค.

๐Ÿ”ฅ 1๏ธโƒฃ ํ์ •๋งฅ์„ ํ™•์ธํ•˜๋Š” ๊ฐ€์žฅ ํฐ ์ด์œ 

๐Ÿ‘‰ Total Anomalous Pulmonary Venous Return (TAPVR)

์ด ์งˆํ™˜์€

  • 4 chamber view๊ฐ€ ์ •์ƒ์ฒ˜๋Ÿผ ๋ณด์ผ ์ˆ˜ ์žˆ์Œ
  • Outflow tract๋„ ์ •์ƒ์ฒ˜๋Ÿผ ๋ณด์ผ ์ˆ˜ ์žˆ์Œ

ํ•˜์ง€๋งŒ

โ— ํ์ •๋งฅ์ด ์ขŒ์‹ฌ๋ฐฉ(LA)์œผ๋กœ ์—ฐ๊ฒฐ๋˜์ง€ ์•Š์Œ

์ด๊ฑธ ๋†“์น˜๋ฉด

์ถœ์ƒ ์งํ›„ ์‹ฌ๊ฐํ•œ ์ฒญ์ƒ‰์ฆ์ด ์ƒ๊ธธ ์ˆ˜ ์žˆ์Šต๋‹ˆ๋‹ค.

๐Ÿ”Ž 2๏ธโƒฃ ์ •์ƒ ํ์ •๋งฅ ํ™•์ธ ํฌ์ธํŠธ

์ •์ƒ์—์„œ๋Š”:

โœ” ์ขŒ์‹ฌ๋ฐฉ posterior wall๋กœ 2๊ฐœ ์ด์ƒ ์œ ์ž… ํ™•์ธ

โœ” Color Doppler์—์„œ LA๋กœ ํ–ฅํ•˜๋Š” flow

โœ” Confluence ๋ณด์ด์ง€ ์•Š์Œ (๊ฐœ๋ณ„ ์œ ์ž…)

๐Ÿšจ 3๏ธโƒฃ TAPVR ์˜์‹ฌ ์†Œ๊ฒฌ

  • LA๊ฐ€ ์ž‘๊ฒŒ ๋ณด์ž„
  • Posterior LA wall ๋’ค์— confluence ๊ตฌ์กฐ
  • Vertical vein ์˜์‹ฌ ๊ตฌ์กฐ
  • 4 chamber view์—์„œ ํ์ •๋งฅ ์œ ์ž… ์•ˆ ๋ณด์ž„

3VT์—์„œ๋Š”

  • ์ถ”๊ฐ€ ํ˜ˆ๊ด€์ด ๋ณด์ผ ์ˆ˜๋„ ์žˆ์Œ

๐Ÿง  4๏ธโƒฃ ์™œ PA๋งŒ ๋ณด๊ณ  ๋๋‚ด๋ฉด ์•ˆ ๋ ๊นŒ?

๋งŽ์€ conotruncal anomaly์—์„œ๋Š”

outflow tract์— ์ง‘์ค‘ํ•˜์ง€๋งŒ

๐Ÿ‘‰ Inflow๋„ equally ์ค‘์š”ํ•ฉ๋‹ˆ๋‹ค.

ํŠนํžˆ:

  • Heterotaxy
  • Right atrial isomerism
  • Complex CHD

์—์„œ๋Š” pulmonary venous return ์ด์ƒ ๋™๋ฐ˜ ๊ฐ€๋Šฅ

๐Ÿ”ฅ 5๏ธโƒฃ ์ž„์ƒ์ ์œผ๋กœ ์ค‘์š”ํ•œ ์ด์œ 

TAPVR๋Š”

  • duct-dependent lesion์ผ ์ˆ˜ ์žˆ์Œ
  • ์‘๊ธ‰ ์ˆ˜์ˆ  ๋Œ€์ƒ
  • ์‚ฐ์ „ ์ง„๋‹จ ์—ฌ๋ถ€๊ฐ€ ์˜ˆํ›„์— ์˜ํ–ฅ

๐Ÿ’ก ์‹ค์ „ ์ฒดํฌ๋ฆฌ์ŠคํŠธ

ํ์ •๋งฅ ํ™•์ธํ•  ๋•Œ:

1๏ธโƒฃ LA posterior wall์— ์œ ์ž… ๋ณด์ด๋Š”๊ฐ€?

2๏ธโƒฃ ์ตœ์†Œ 2๊ฐœ ์ด์ƒ ํ™•์ธํ–ˆ๋Š”๊ฐ€?

3๏ธโƒฃ Color Doppler ๋ฐฉํ–ฅ ์ •์ƒ์ธ๊ฐ€?

4๏ธโƒฃ ์ด์ƒ confluence ๋ณด์ด๋Š”๊ฐ€?

๐Ÿ”ฅ ํ•œ ์ค„ ์ •๋ฆฌ

Outflow๊ฐ€ ์ •์ƒ์ด๋ผ๊ณ  ํ•ด์„œ ์‹ฌ์žฅ์ด ์ •์ƒ์€ ์•„๋‹ˆ๋‹ค.

ํ์ •๋งฅ์ด ์ขŒ์‹ฌ๋ฐฉ์œผ๋กœ ๋“ค์–ด์˜ค๋Š”์ง€ ๋ฐ˜๋“œ์‹œ ํ™•์ธํ•ด์•ผ ํ•œ๋‹ค.

๊ธ€์“ด์ด

UltraLog

I share practical fetal ultrasound knowledge based on real clinical experience.

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