经胸实时三维超声心动图在房间隔缺损诊疗中的应用价值

Value of real-time three-dimensional echocardiography in the diagnosis and treatment of atrial septal defect

目的 :探讨实时三维超声心动图在房间隔缺损诊疗中的临床应用价值。方法 :应用PhilipsSonos 75 0 0实时三维超声成像系统获取 32例先天性房间隔缺损患者的三维数据库 ,利用三维数据工作站对缺损大小进行测量分析 ,部分病例的三维测量值与二维经胸和 (或 )经食道超声测量值、球囊伸展径和 (或 )手术结果对照。对其中 4例中央型房缺患者在实时三维超声心动图监测下 ,经心导管行房缺封堵术。结果 :实时三维成像能从多个视角、甚至模拟手术路径立体显示房间隔缺损的金貌 ,包括缺损的整体形态、部位、大小、残端 ,以及与周边组织的毗邻关系 ;同二维超声所测直径相比 ,三维超声测量结果与介入或手术结果具有更好的相关性 (r =0 .97vsr =0 .88) ,并能更准确引导房间隔介入手术。结论 :与二维超声心动图比较 ,实时三维超声心动图反映了房间隔缺损的立体空间结构 ,可对缺损大小进行准确的定量分析 ,同时在引导介入手术中提供快速而准确的监测手段 ,具有重要的临床应用潜力。

Objective:To investigate the clinical application of real-time three-dimensional echocardiography (RT 3DE) in the diagnosis and treatment of atrial septal defects(ASD).Methods:Thirty-two patients with ASD were studied with RT 3DE of Philips Sonos 7500. 12 patients underwent surgery therapy; 12 patients underwent transcatheter closure, and 4 patients were guided by RT 3DE. 3D image database was post-processed using 3D work-station. The results were compared with those measured by two-dimensional transthoracic echocardiography (2D TTE) ,transesophageal echocardiography (2D TEE), stretched balloon diameter (SBD) and (or) surgical results.Results:The defects were delineated objectively frommany unique directions and angles by RT 3DE that would not be available with other current techniques, even simulated intraoperative visualization. The stereoscopic views of ASD including the shape, location, size, rims of the ASD, and its spatial relation to the surrounding structures could be appraised in their nature. For maximal ASD size measurement, the best correlation was found between RT 3DE measurements and the SBD, whereas 2DE was smaller than the other two methods(r=0.97vs,r=0.88). RT 3DE guided the transcatheter closure procedure successfully.Conclusion:Compared with the routine 2DE, RT 3DE provides en face stereoscopic views of ASD; thus,it can accurately measure the size of ASD. Meanwhile RT 3DE can provide a rapid and accurate method for monitoring and guiding the transcatheter closure procedure. RT 3DE has important applied potentiality in clinical field.