经导管主动脉瓣植入术患者冠状动脉开口位置的三维超声研究

A study of location of coronary artery ostia in transcatheter aortic valve implantation procedure using three dimensional echocardiography

目的 探讨经食管实时三维超声心动图（RT-3D TEE）测量冠状动脉开口与主动脉瓣环间距离的准确性.方法 18例因主动脉瓣狭窄行经导管主动脉瓣植入术的患者,术中采集主动脉根部RT-3DTEE图像,重建主动脉瓣环,生成瓣环高度参数（H）,同时使用超声及多排螺旋CT分别测量左冠状动脉开口-主动脉瓣环距离（E-LAA、C-LAA）及右冠状动脉开口-主动脉瓣环距离（E-RAA、C-RAA）.结果 18例患者中右冠状动脉显示率为94.4％（17/18）,左冠状动脉显示率为88.9％（16/18）.主动脉瓣环高度H低于超声和CT所测量的冠状动脉开口-主动脉瓣环间的距离,差异有统计学意义（P＜0.05）；同侧冠状动脉开口位置在RT-3D TEE和MDCT两种测量方式组间测值差异无统计学意义（P＞0.05）.结论 RT-3D TEE不仅能显示冠状动脉开口,还可显示并测量冠状动脉开口与主动脉瓣环的距离.

Objective To study the the feasibility of real-time 3D transesophageal echocardiography （RT-3D TEE） in measuring the distance between the coronary artery ostia and the aortic annulus.Methods RT-3D TEE image of aortic root was collected intraoperatively in 18 cases who were refered to our center for transcatheter aortic valve implantation.The aortic annulus was reconstructed and the height of the annulus （H） was generated.Meanwhile RT-3D TEE and MDCT was used to determine the left coronary artery ostia-aortic annulus distance （E-LAA,C-LAA） and the right coronary artery ostia-aortic annulus distance （E-RAA,C-RAA）.Results The display rate of right coronary artery was 94.4％ （17/18）,with the left coronary artery 88.9％ （16/18） on the RT-3D TEE imaging.The height of the annulus（H） was lower than the distance between the coronary artery ostia and the aortic annulus（P ＜0.05）.No statistically significant differences was found in the parameters of the distance between the coronary artery ostia and the aortic annulus between RT-3D TEE and MDCT （P ＞0.05）.Conclusions RT-3D TEE imaging can display and measure the distance between the coronary artery ostia and the aortic annulus.