实时三维超声心动图对成人房间隔缺损的再认识

Further recognition of real-time three-dimensional echocardiography in adult atrial septal defect

目的 利用实时三维超声心动图对成人房间隔缺损再认识。方法 对 17例成人房间隔缺损进行了常规二维超声检查及实时三维超声心动图 3种技术 (Live-3D、Fullvolume、3D-color)的详细探测。结果 经过实时三维任意切割图像立体观察,可清楚地显示房间隔的全貌,缺损完整的空间结构、大小、形态、部位、范围、动态变化、与上腔静脉下腔静脉的关系、残留房间隔的立体结构等,缺损形态前后径 >上下径类椭圆形 11例 (占64. 7% ),类圆形 4例(占 23. 5% ),不规则形 2例(占 11. 8% )。二维超声测量的缺损最大径与三维超声测量的较大径之间的相关性较低(r=0. 72,P<0. 002),二者差异有显著性意义(t=2. 823,P<0. 01);二维超声测量的缺损最大径与术中实测最大径之间的相关性较低(r=0. 75,P<0. 002),二者差异有显著性意义(t=2. 359,P<0. 05);而术中实测最大径与三维超声测量较大径之间的相关性较高 (r=0. 92, P<0. 001),二者差异无显著性意义(t=0. 416,P>0. 05)。结论 实时三维超声心动图显示房间隔缺损大多为类椭圆形,并非类圆形,大多前后径>上下径,而传统二维超声测量的缺口大小均为上下径,故常低估了缺损真正的大小。

Objective To further explore the diagnosis of atrial septal defect(ASD) by real-time three-dimensional echocardiography(RT-3DE).Methods Seventeen adult patients with ASD were carefully examined by conventional two-dimensional echocardiography(2-DE) and the three techniques of RT-3DE(Live-3D,Full volume,3D-color).Results To study the RT-3DE images in multiple orientations and cross sections,the stereoscopic views of ASD were displayed clearly,including the location,size,morphology,spatial relationships with superior vena cava and inferior vena cava,the stereoscopic structure of atrial septal retained and so on.Among 17 cases of ASD,there were 11 cases ((64.7%)) with oval-like defects,their anterior-posterior distance >the upper-nether distance,4 cases with round-like defects((23.5%)),2 cases with irregular defects((11.8%)).The maximal diameters obtained from 2-DE were significantly lower than those from RT-3DE(r=(0.72),P<(0.002)),the maximal diameters obtained from 2-DE were significantly lower than those from surgery (r=(0.75),P<(0.002)),but the maximal diameters measured in surgery had better correlation with RT-3DE results than with 2-DE (r=(0.92),P<(0.001)).Conclusions The ASD examined by RT-3DE are always oval-like,but not round-like,their anterior-posterior distance >the upper-nether distance.But the sizes measured by 2-DE are all the upper-nether distance,so the real size of ASD often underestimated.