各种测量房间隔缺损方法在房间隔缺损治疗中的价值比较

Comparison on Values of Several Methods for Measurement of Atrial Septal Defect in Its Treatment

目的 对房间隔缺损 (ASD)患者采取经胸壁二维超声心动图 (TTE)、经食道动态三维重建、球囊导管及开胸测量缺损直径并相比较 ,评价各种测量ASD方法在ASD治疗中的价值。方法 46例患者均接受TTE检查和经食道动态三维重建。 ( 1)对 3 0例适宜Amplatzer封堵治疗的患者 ,将重建所得ASD最大直径、TTE最大直径和球囊导管测量直径相比较 ,并且ASD重建最大直径、TTE最大直径分别与球囊导管测量直径行相关分析。 ( 2 ) 16例不适宜封堵的患者 ,将重建所得的ASD最大直径与TTE及开胸测量缺损最大直径相比较。结果 ASD直径的TTE、三维重建测量值与球囊测量值相比较有差别 ,但两者与球囊测量值均相关良好。三维重建与球囊测量值回归方程的标准误差较小。TTE测量值与开胸测量值相比较无差别 (P >0 .0 5 ) ,但经食道超声心动图三维重建测量值与开胸测量值相比较有差别 (P <0 .0 5 ) ,大于开胸测量值。结论 TTE可以作为ASD的筛查方法 ,而经食道超声心动图三维结构重建测值则可作为选择ASD治疗方案以及封堵器大小的重要参考。对于采取开胸手术的患者 。

Objective To compare the values of several methods for measurement of diameter of ASD in its treatment by measuring the atrial septal defect(ASD) diameters with transthoracic echocardiography(TTE),transesophageal three-dimensional echocardiography,Foley's tube and the operation.Method 46 patients were all examined with TTE and transesophageal three-dimensional echocardiography.(1)In 30 cases who fitted Amplatzer blocking therapy,the maximum ASD reconstruction diameter,the maximun TTE diameter and diameter from Foley's tube were compared and their correlations were analyzed.(2)Other 16 patients were observed through operation.The largest TTE diameters,reconstructed diameters were compared with those measured in the operation.Results There were significant differences among diameters measured by TTE,three-dimensional reconstructed images and Foley's tube(P<0.05),but both sizes of TTE and reconstructed images had significant correlations with those of Foley's tube.The standard error of linear regression between reconstructed images and balloon stretched diameters was small.TTE sizes had no significant difference with those of operation(P>0.05).Conclusions TTE could be used as a screening method of ASD,while transesophageal three-dimensional echocardiography plays an important role in the selections of therapy and occluder.For patients who accept operation,TTE examination is enough.