经胸实时三维超声心动图检测结构性心脏病的临床价值

Real-time three-dimensional transthoracic echocardiography in assessment of structural heart diseases

目的:评价经胸实时三维超声心动图(RT3D-TTE)在诊断结构性心脏病中的临床应用价值。方法:对结构性心脏病患者256(患病组,男154,女102)例,年龄(33±9)岁,其中包括142例先天性心脏病患者、85例瓣膜病、9例心脏肿瘤和26例心腔内血栓(其中6例同时患有风湿性二尖瓣狭窄),同时行二维超声心动图(2D-TTE)和RT3D-TTE检查,以外科手术所见和组织病理学检查做为标准诊断(金标准),并以260名年龄与性别与患病组相匹配的健康志愿者做为正常对照组,比较两种超声检查结果。结果:所有的病例中,RT3D-TTE能够成功显示和诊断绝大部分的结构性心脏病,其诊断真实性指标,包括灵敏度、特异度和准确度与2D-TTE均无显著性差异。与2DTTE比较,RT3D-TTE实现了心脏结构的立体可视化,能够直观地显示房、室间隔缺损的大小、形状及毗邻关系,能为法洛四联症、完全性大动脉转位等较复杂的先天畸形提供更详实的的结构信息和分型的证据,能多视角、全方位地显示二尖瓣、主动脉瓣等各瓣膜的形态,准确评价其启闭功能,能完整显示心脏肿瘤和血栓,确定其基底部位置、大小、形状以及与周围结构的关系。结论:应用RT3D-TTE评估结构性心脏病是可行的,并能够提供更为详细的解剖和功能信息。

AIM：To evaluate the clinical value of realtime threedimensional transthoracic echocardiography （RT3DTTE） in the diagnosis of structural heart diseases. METHODS： Two hundred and fiftysix patients [mean age （33±9） years, 154 males] with suspected structural heart diseases and 260 age and gendermatched normal control subjects underwent 2DTTE and RT3DTTE. Of the patients, 142 had congenital heart diseases, 85 had valvular diseases, nine had cardiac tumors and 26 had cardiac thrombi; six patients also had rheumatic mitral stenosis. The findings of 2DTTE and RT3DTTE were compared. RESULTS： Although no significant difference was found in measurements of diagnostic accuracy of structural heart diseases between RT3DTTE and 2DTTE, RT3DTTE provided a better view of the cardiac anatomic structures. RT3DTTE visualization of septal defects allowed optimal assessment of the shape, size, site and number of interatrial or interventricular defects and provided a comprehensive anatomic evaluation and characters of subtypes for complicated heart diseases such as tetralogy of Fallot and complete transposition of the great arteries. RT3DTTE could optimally visualize the surface and anatomy of mitral, aortic and other valves from multiple views, assess valvular open and close function accurately and display intracardiac masses and thrombi integrally, delineating their basal sites, shapes, sizes and relationship with adjacent structures. CONCLUSION： Application of RT3DTTE in the assessment of patients with structural heart diseases is feasible and allows more accurate anatomic and functional assessment.