实时三维超声心动图在先天性心脏病诊断中的应用

Application of real-time full volume three-dimensional echocardiography in patients with congenital heart diseases

目的探讨实时三维超声心动图(RT-3DE)对先天性心脏病的诊断价值.方法选取56例先天性心脏病患者分别行二维超声心动图及RT-3DE检查,采集二维、实时三维及全容积三维图像,分析比较3种超声显像技术对心血管解剖结构的显示能力,并对20例室间隔缺损(VSD)、房间隔缺损(ASD)患者缺损最大直径的二维及三维超声测值与手术测值进行比较.结果RT-3DE可以:(1)实时显示心脏的立体结构;(2)实时显示室间隔或房间隔缺损的空间位置、形态,测量的缺损最大直径与手术测值无显著差异(P>0.05);(3)完整显示先天性心脏瓣膜病的瓣叶位置、数目、狭窄口面积及功能状态,清晰显示心内膜垫缺损的共同房室瓣形态及数目,并清晰显示肺动脉瓣病变患者的肺动脉瓣发育情况;(4)清晰显示法乐四联症患者病变的复杂结构,尤其在主动脉根部的短轴观方位显示室间隔的骑跨程度;(5)清晰显示部分动脉导管未闭患者的导管走行及形态.结论 RT-3DE能实时显示先天性心脏病的立体结构及功能状态,为外科手术提供更多信息.

Objective To investigate the clinical application of real-time three-dimensional echocardiography （RT-3DE） in patients with congenital heart diseases. Methods Two-dimensional echocardiography （2-DE） , RT-3DE and full volume three-dimensional echocardiography （FV-3 DE） were performed in 56 patients with various congenital heart diseases, in which the results of 20 patients derived by echocardiography were compared with that of operations. Results Compared with conventional 2-DE technique, RT-3DE and FV-3DE had the advantages in the following aspects： instantly depicting three orthogonal planes and spatial relationships of any cardiac structure; displaying the location and morphology of atrial or ventricular septal defects instantly, without significant difference between the diameters of atrial or ventricular septal defects derived by 3 DE and surgical operation （ P 〉 0.05 ） ; revealing the numbers and motion of valves in congenital valvular diseases, especially in bicuspid aortic valves, pulmonary hypoplasia and common atrioventricular valve in short axis orientation; observing the complex deformation of Fallot tetralogy, especially the overriding of the ventricular septum in aortic short axis orientation; displaying patent dutus arterious. Conclusions The real-time three-dimensional echocardiography provides a reliable techniques displaying cardiac structures and function unobtainable by 2-DE, which may enhance the qualitative and quantitative diagnostic accuracy and produce potential clinical values for congenital heart diseases.