实时三维超声心动图诊断先天性双孔二尖瓣畸形的初步研究

Initial observation of double orifice mitral valve by real-time three-dimensional echocardiography

目的探讨实时三维超声心动图(RT-3DE)观察先天性双孔二尖瓣畸形(DOMV)的应用价值。方法5例先天性DOMV患者,在常规二维超声心动图基础上,应用RT-3DE实时显像、全容积显像及彩色成像模式,观察畸形二尖瓣立体形态及血流动力学改变。结果5例先天性DOMV中,3例合并部分型房室间隔缺损,2例为单纯性双孔二尖瓣;2例合并有瓣裂,无瓣裂者3例;5例患者均伴有不同程度的二尖瓣关闭不全(中-重度3例,轻度1例,功能正常1例)。术前二维超声提示3例DOMV,漏诊2例(其中1例术后复查时提示)。实时三维超声提示4例DOMV,1例术前未行实时三维超声检查,术后复查时提示。结论与二维超声心动图比较,实时三维超声心动图能更全面、立体地显示二尖瓣的空间结构,提高对DOMV诊断的准确性,可作为传统二维超声心动图的重要补充。

Objective To demonstrate the usefulness of real-time three-dimensional echocardiography （RT-3DE） in the di- agnosis of double orifice mitral valve （DOMV）. Methods Five DOMV cases were examined using 2DE and RT-3DE. Resuits DOMV associated partial atrioventricular septal defect was found in 3 cases （in which 2 had cleft mitral valve） and isolated DOMV in 2 cases, which had moderate to severe mitral regurgitation was in 3 cases, and mild mitral regurgitation in 1, no regurgitation in 1; 1 had complicated rhumatic heart disease; 3 cases were preoperatively discovered by 2DE, while 2 missed （1 case was discovered postoperatively）; 4 cases were diagnosed by RT-3DE preoperatively, 1 case was diagnosed postoperatively （not examined by RT-3DE preoperatively）. Conclusion RT-3DE is a reliable technique in the diagnosis of DOMV, which permits a comprehensive noninvasive assessment of mitral valve and may supplement 2D TTE in the assessment of DOMV.