实时三维超声心动图评价人工瓣膜形态和功能的初步研究

Assessment of prosthetic valves with live three-dimensional echocardiography: an initial study

目的评价实时三维超声(Live3DE)技术观察人工瓣膜形态和功能的可行性和准确性。方法32例行二尖瓣和(或)主动脉瓣以及三尖瓣位人工瓣膜置换的患者,应用Live3DE的灰阶成像和彩色成像模式,观察人工瓣和支架的结构形态,并评价其相关血流动力学改变。结果Live3DE灰阶成像可清晰显示二尖瓣位或三尖瓣位上人工瓣膜和支架结构形态以及其空间立体关系,三维成像清晰率为83.33%(15/18);8例二尖瓣合并主动脉瓣置换的患者,受主动脉瓣位机械瓣强回声遮挡的影响,人工二尖瓣的三维成像清晰率为62.5%(5/8);人工主动脉瓣的三维成像清晰率则为50%(7/14)。Live3DE彩色血流成像则可较敏感地显示人工瓣的反流与瓣周漏。结论联合应用Live3DE的灰阶和彩色成像模式可准确、直观地反映人工瓣膜的形态结构和功能变化,是传统经胸二维超声心动图和经食管超声心动图技术的重要补充。

Objective To evaluate the possibility and accuracy of live three-dimensional echocardiography （Live 3DE） in the assessment of the prosthetic valve apparatus＇s configuration and function in patients with prosthetic valves replacement. Methods Thirty-two patients experienced the mitral valve （MV） replacement or/and aortic valve （AV） replacement, or tricuspid valve （TV） replacement separately. Live 3DE was used to observe the structure, neighbor relationship of artificial valve and its bracket, and evaluate hemodynamic changes. Results 83.33%（15/18） patients with MV replacement, TV replacement could be successfully observed by live gray-scale 3DE; the structure and motion of prosthesis MV in 62.5% （5/8） patients with MV and AV replacement could be successfully observed by live gray-scale 3DE. There was still a problem to accurate display the structure and the motion of prosthetic AV, the appearance rate was only 50% （7/14）. Live color 3DE could be used to assess the valve regurgitation and the leakage around the prosthetic valve. Conclusion Prosthetic valve apparatus＇s structure, motion and the flow dynamics could be accurately detected by Live 3DE. Live 3DE is recognized as an important complement of transthoracic echocardiography （TTE） and transesophageal echocardiography （TEE） when assessing prosthetic valve function.