重度主动脉瓣狭窄患者瓣环径二维及三维测量方法的比较

Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters in patients with severe aortic stenosis

目的 比较不同的二维及三维方法对重度主动脉瓣狭窄患者瓣环径测值的差别,探讨最优测量手段.方法 32例重度主动脉瓣狭窄患者,分别行二维经胸超声心动图（TTE）、二维经食管超声心动图（TEE）及多排螺旋CT（MSCT）三维成像测量主动脉瓣环径.结果 MSCT显示主动脉瓣环为椭圆形结构,其长轴径（26.9±2.9）mm,短轴径（21.3±1.8）mm,长轴径与短轴径差异有统计学意义（P＜0.01）.TTE及TEE方法仅提供一个瓣环值,分别为（23.2±2.0）mm及（23.4±2.0）mm,均显著小于MSCT所测长轴径和短轴径的平均值（24.1±2.1）mm（P＜0.05）.结论 主动脉瓣环为椭圆形,瓣环径的测量采用三维MSCT方法更佳.

Objective To compare different two-dimensional （2D） and three-dimensional （3D） imaging techniques for aortic annulus measurement in patients with severe aortic stenosis and determine the most accurate method. Methods In 32 consecutive patients with severe aortic stenosis, 2D transthoraeie echocardiography （rITE）, 2D transesophageal eehocardiography （TEE）, and 3D multisliee computed tomography （MSCT） were per- formed to determine aortic annulus diameters. Results The aortic annulus has an oval shape with its long-axis diameter （26.9±2.9）mm, short-axis diameter （21.3±1.8）ram measured by MSCT and the 2 diameters were significantly different（P〈0.01 ）. 2DTTE （23.2±2.0）mm and TEE （23.4±2.0）mm provided only one diameter of the aortic annulus which was significantly lower than the mean of long-axis and short-axis diameters （24.1±2.1）mm （P〈 0.05 ）. Conclusion MSCT 3D imaging should be used to evaluate aortic annulus diameters, as 2D imaging tech- niques, providing only one diameter, underestimate them. MSCT measurement may have important potential clini- cal implications on transeatheter aortic valve implantation（TAVI） strategy and further studies are required.