卵圆孔未闭封堵中实时三维超声心动图的应用效果及临床意义研究

Application and Clinical Significance of Real-time Three-dimensional Echocardiography in Patent Foramen Ovale Occlusion

目的探讨实时三维超声心动图在卵圆孔未闭封堵中的应用效果及临床意义。方法选择2018年5月至2020年3月武汉科技大学附属武汉亚心总医院收治的卵圆孔未闭患者83例,患者均拟行封堵术治疗,术前、术中及术后分别行经胸超声心动图检查和实时三维超声心动图检查,并将两种方法检查结果进行比较;绘制受试者工作特征曲线(ROC曲线),分析实时三维超声心动图在卵圆孔未闭封堵患者中的应用价值。结果经胸超声心动图检查确诊74例,诊断符合率为89.16%;实时三维超声心动图检查确诊80例,诊断符合率为96.39%。经胸超声心动图检查与实时三维超声心动图检查卵圆孔未闭不同类型比较,差异无统计学意义(P>0.05);术后患者复查实时三维超声心动图,结果显示:封堵器位置正确,塑形良好封堵器与房间隔贴合紧密,未见残余分流。ROC曲线结果表明:实时三维超声心动图在卵圆孔未闭封堵患者ROC曲线下面积为0.857,诊断灵敏度为0.835,特异度为0.681。结论实时三维超声心动图用于卵圆孔未闭封堵患者中能提供大量的信息,在术前病例筛选、术中引导及术后随访中具有重要意义,能获得良好的应用灵敏度,可为临床诊疗提供参考依据,值得推广应用。

Objective To investigate the effect and clinical significance of real-time three-dimensional echocardiography in the occlusion of patent foramen ovale.Methods A total of 83 patients with patent foramen ovale from May 2018 to March 2020 were selected as the subjects.All patients were planned to undergo occlusion.Transthoracic echocardiography and real-time three-dimensional echocardiography were performed preoperatively,intraoperatively and postoperatively,respectively,and the monitoring results of the two methods were compared.The ROC curve was drawn to analyze the application value of real-time three-dimensional echocardiography in patent foramen ovale occlusion patients.Results 83 cases of patent foramen ovale were confirmed by clinical examination,among which 74 cases were confirmed by chest echocardiography,the diagnostic coincidence rate was 89.16%(P<0.05).80 cases were confirmed by real-time three-dimensional echocardiography,and the diagnostic coincidence rate was 96.39%.There was no statistical significance between transthoracic echocardiography and real-time three-dimensional echocardiography for patent foramen ovale(P>0.05).The real-time three-dimensional echocardiography of the patient was reexamined after the operation,and the results showed that the occlusion device was in correct position,the occlusion device was well shaped and fitted closely to the atrial septum,and no residual shunt was observed.The results of ROC curve showed that the AUC value of the real-time three-dimensional echocardiography in the patent foramen ovale occlusion patients was 0.857,the diagnostic sensitivity was 0.835%,and the specificity was 0.681%.Conclusion Real-time three-dimensional echocardiography can provide a lot of information for patent foramen ovale occlusion patients,and it is of great significance in preoperative case screening,intraoperative guidance and postoperative follow-up.It can obtain good application sensitivity and provide reference for clinical diagnosis and treatment,which is worthy of popularization and application.