经食管实时三维超声心动图对三尖瓣环径测量位点的研究

Application of real-time three-dimensional transesphaogeal echocardiography in quantitation of tricuspid valve annulus diameter

目的探讨在右室流出道切面测量三尖瓣环径（TVD）的可行性与准确性。方法75例因左心瓣膜损害而行瓣膜置换术患者，根据反流程度分为轻度、中度、重度3组。术前经胸超声心动图（TTE）在心尖四腔观测量TVD（TTE—TVD）；术中开胸前分别于食管中段四腔观（TEE）、右室流入（RVIT）及流出道观（RVOT）进行超声成像，分别测量最大TVD，并观察麻醉后与术前三尖瓣反流程度的变化。同时使用经食管实时三维超声（RT3DTEE）及其瓣环定量软件观察三尖瓣环立体形态变化。结果75例患者组内对比：TTE—TVD、TEE-TVD及RVIT—TVD测值之间差异无明显统计学意义（P〉0．05），而RVOT—TVD均明显大于同组其他切面测值（P〈0．05）；组间比较：轻度与中度反流组患者同一切面测值间差异无统计学意义，重度反流组与前两组比较则各切面测值差异有统计学意义（P〈0．05）。全麻后三尖瓣反流程度均较术前有一定程度减轻；RT3DTEE显示三尖瓣环“马鞍状”立体结构演变为狭长的平面状结构，瓣环主要朝向背离三尖瓣隔瓣方向扩张。结论右室流出道切面所测瓣环径能反映TVD扩张最大程度，并能有效指导患者三尖瓣成形术决策选择。

Objective To verify the feasibility and accuracy in the measurement of tricuspid valve annulus diameter（TVD） in the right ventricular outflow tract view. Methods Seventy five patients under the valve replacement surgery for the left heart valve lesions were divided into mild, moderate and severe group according to the severity of the regurgitation. The TVD was get on the apical four-chamber heart view preoperatively by transthoracic echoeardiography（TTE）,noted as TTE-TVD, meanwhile it was also get by the transesophageal echocardiography on the four-chamber view （TEE-TVD）, right ventricular inflow （RVIT-TVD） and outflow tract view（RVOT-TVD）. The changes of tricuspid regurgitation severtity was observed preoperatively. And the morphology of tricuspid annulus were observed using both real-time three- dimensional transesophageaI echocardiography （RT 3D TEE） and the quantitative software. Results Comparison in the groups：no statistically significant difference （ P ~0.05） was found between TTE-TVD, TEE-TVD and RVIT TVD;while the RVOT-TVD was significant greater than that in the same group from other views （ P d0.05）. Comparison between the groups：no significant difference was found between mild and moderate regurgitation group on the same view. There was a significant difference of the TVD between the severe regurgitation group and the former two groups on each view（ P d0.05）. The severity of tricuspid regurgitation in intraoperative anesthesia was reduced. The ＂saddle＂ tricuspid ring evolved into the narrow planar structure on the RT-3D TEE. For the expansion of the annulus,it departure from the tricuspid septal leaflet. Conclusions TVD measured on the right ventricular outflow tract view reflect the maximum expansion of the tricuspid valve annulus diameter, and can effectively guide the decision-making choices of the surgeon.