三维超声心动图评估发育不良型三尖瓣结构的价值

Evaluation of the structure of tricuspid valve with three dimensional echocardiography in hypoplastic right ventricle

目的应用三维超声心动图探讨右心室发育不良时三尖瓣装置的结构特点。方法28例诊断为右心室发育不良的患儿，按照三尖瓣反流程度分为反流组（三尖瓣反流中度及以上）与非反流组（三尖瓣反流轻度及以下）。18例年龄匹配的正常儿童作为对照组。应用实时三维超声心动图测定右心室容积、三尖瓣瓣环面积、三尖瓣各瓣叶的面积以及瓣尖至最近乳头肌顶点的距离。测值应用体表面积（BSA）进行标化。结果右心室发育不良患儿组的右心室容积显著低于正常组，三尖瓣瓣环面积与右心室容积显著相关（r=0．90，P〈0．0001）。在三尖瓣反流组，三尖瓣前瓣面积与瓣环面积的比值较非反流组以及正常组显著增加，而后瓣所占比值显著缩小。右心发育不良组各瓣尖至相邻乳头肌顶点的距离显著小于正常组。反流组隔瓣瓣尖至相邻乳头肌距离显著小于非反流组（P=0．0023）。结论三维超声心动图可以用来评估先天性心脏病三尖瓣病变。右心室发育不良患儿后瓣发育不良以及隔瓣腱索偏短可能是三尖瓣反流的原因。

Objective To reveal the character of tricuspid valve in hypoplastic right ventrieular heart syndrome （HPRVHS） using 3-dimensional echocardiography（3DE）. Methods Twenty eight patients with HPRVHS were included in the study, and they were divided into two groups according the degree of tricuspid regurgitation. Eighteen normal children were included as the control. Volume of right ventricle（VRV）, area of tricuspid annulus（TVA ）, proportion of the leaflets and the distance from tips of leaflets to the nearest papillary muscle were measured with 3DE. These data was standardized by body surface area. Results The volume of right ventricle in HPRVHS was significantly less than that in normal group. The area of tricuspid annulus was significantly correlated with volume of right ventricle（ r = 0. 90, P 0. 0001）. In the tricuspid regurgitation group, the proportion of area of anterior leaflet to area of tricuspid annulus was significantly higher than non-regurgitation group and normal group（ P〈0.0001 ）. Respectively, the proportion of the area of posterior leaflet to the area of tricuspid annulus in regurgitation group was significantly less than normal and non- regurgitation group. The distance from tips of leaflets was significantly shorter in HPRVHS than in normal group. Furthermore,the distance from the tip of septal leaflet to the nearest papillary muscle was shorter in regurgitation group than non-regurgitation group （ P = 0. 0023）. Conclusions 3DE could be applied for evaluating the pathologic change of tricuspid valve in congenital heart disease. In HPRVHS, hypoplastic of posterior leaflet and shortness of the cords of septal leaflet could be the cause of tricuspid regurgitation.