经胸三维超声心动图诊断先天性心脏间隔缺损与二维超声心动图诊断的对照研究

Application of Transthoraic Three-Dimensional Echocardiography in the Diagnosis of Congenital Cardiac Septal Defects in Children-Compared with Two-Dimensional Echocardiography

目的: 探讨经胸三维超声心动图(3DTTE)诊断先天性心脏间隔缺损的可靠性和优越性。方法: 选取彩色经多普勒二维超声心动图(CDE)诊断并接受手术治疗的VSD52例,ASD20例。术前应用HPSONOS5500型超声心动仪和Tomtec4DCardio ViewRT三维超声成像系统进行3DTTE诊断。结果: (1)52例VSD按手术结果分为膜周型35例,双动脉瓣下型17例,与术前3DTTE诊断和CDE诊断完全吻合;VSD手术测值为9. 28±3. 19mm,与3DTTE测值(8. 82±2. 92mm)具有良好相关性(r=0. 88,p<0. 01);与CDE测值(8. 69±3. 42mm)也具有良好相关性(r=0. 65,p<0. 01)。在诊断VSD合并症方面,手术显示合并三尖瓣隔瓣腱索脱入缺损处者4例, 3DTTE在术前均做出正确诊断,但CDE漏诊2例,误为两处VSD者1例,误为主动脉瓣下隔膜者1例;手术显示合并主动脉瓣脱垂者4例, 3DTTE在术前亦均做出正确诊断,而CDE漏诊2例。(2)20例ASD按手术结果分为继发孔型17例、下腔静脉型2例和上腔静脉型1例,与术前3DTTE诊断吻合,而CDE术前诊断均为继发孔型ASD。20例ASD最大长轴径和最大短轴径的手术测值分别为19. 5±4. 2mm和14. 8±3. 7mm。3DTTE估测ASD最大长轴径和最大短轴径分别为18. 8±3. 7mm和14. 0±3. 3mm,与手术测值均具有高度相关性(r=0. 93和r=0. 92,p<0. 01);

Objective: To assess the reliability and advantage of transthoracic three-dimensional echocardiography (3DTTE) in the diagnosis of congenital cardiac septal defects. Methods: 52 patients with VSD and 20 patients with ASD were diagnosed by using 3DTTE and transthoracic two-dimensional color Doppler echocardiography (CDE), and the results were compared with surgical findings. 3DTTE was carried out by using HP/SONOS5500 with 5MHz transthoracic Omniplane rotational probe and Tomtec/4D Cardio-View RT software. Results: ①The types of VSD defined by surgery included perimembranous VSD (35) and doubly committed VSD (17), which were consistent with both CDE and 3DTTE findings. Mean diameter at major axis of VSD measured on surgery was 9.28±3.19mm, which was excellently correlated with that measured by 3DTTE ( 8.82±2.92mm) (r=0.88, p<0.01) and well correlated with that measured by CDE (8.69±3.42mm) (r=0.65, p<0.01). However, CDE could not define abnormal tricuspid chordae crossing the defect that happened in 4 patients with perimembranous VSDs, in whom 1 was misdiagnosed as double VSDs and 1 was misdiagnosed as diaphragm infra aortic valve. CDE only detected 2 out of 4 prolapse of aortic valve in those doubly committed VSDs. In contrast, 3DTTE displayed all the problem described above. Moreover, 3DTTE permitted detailed assessment of the positions, sizes, shapes of VSDs. ②Types of ASD defined by surgery included secundum (17), inferior veno caval (2) and superior veno caval (1), which conformed 3DTTE findings. However, CDE failed to differenciate secundum ASD from other types in this group. The diameters of ASDs at major and minor axis measured on surgery were 19.5±4.2mm and 14.8±3.7mm, which were highly correlated with those measured by 3DTTE (18.8±3.7mm and 14.0±3.3mm, respectively) (r=0.93 and 0.92,respectively, p<0.01). Mean diameter of ASD measured by CDE was 18.6±4.1mm, which was also well correlated with surgical measurement(r=0.86,p<0.01). Conclusion: 3DTTE provides better information on spatial recognition of the VSD and ASD and their relationship to the surrounding anatomic structures as compared with CDE, and it may become an optimal tool for clinical diagnosis in congenital cardiac septal defects.