经食管实时三维超声心动图的临床应用

Primary study of the utility of transesophageal real-time three-dimensional echocardiography

目的探讨经食管实时三维超声心动图（RT-3D-TEE）的临床应用价值。方法应用PhilipsiE33型超声诊断仪,X7-2t经食管纯净波矩阵多平面实时三维探头,对44例患者进行RT-3D-TEE检查。其中心腔内血栓待排除患者18例,房间隔缺损7例,心瓣膜病18例（风湿性心脏病二尖瓣狭窄6例,二尖瓣脱垂10例,人工机械瓣瓣周漏1例,三尖瓣脱垂1例）,黏液瘤1例。术中监测26例。结果RT-3D-TEE能够实时直观地显示心脏立体解剖结构的三维图像;显示房间隔缺损部位和范围,在微创外科封堵术中实时全程监测,引导封堵器的植入。心脏瓣膜病术前能够清晰地显示心脏瓣膜及其病变,术后即刻可观察成形术效果或评价人工瓣膜功能。结论RT-3D-TEE操作简便、实时采集、快速成像,可同步显示三维立体影像,分辨率高,图像质量好,在临床应用,尤其在心脏外科术中应用前景广阔。

Objective To investigate the value of real-time three-dimensional transesophageal echocardiography（RT-3D-TEE）in the diagnosis of cardiovascular diseases.Methods Philips iE33 was used to detect forty-four patients [30 male,14 female,mean age（49.74±12.84）years],in which 18 patients with suspected intracardiac thrombosis,7 with congenital heart disease,18 with valvular disease（6 mitral valve stenosis,10 mitral valve prolaps,1 periprosthetic valve leakage,1 tricuspid valve prolapse）and 1 with myxomas.Twenty-six patients were monitored during operation.Results RT-3D-TEE could show the 3D-anatomy structure of heart on line.It could detect the position,size and shape of atrial septal defect,guiding and monitoring minimally invasive closure of secundum atrial septal defects by the Amplatzer septal occluder.RT-3D-TEE could identify valvular apparatus and their defects,show cardiac thrombosis and tumours clearly.Conclusions RT-3D-TEE can be operated easily,obtaining 3D imaging on-line.The imaging obtained by RT-3D-TEE has high resolution and better view quality.Thus,RT-3D-TEE could provide adequate valuable information for accurate diagnosis of cardiovascular disease and has wide prospect in clinic application,especially in cardiac surgery.