实时三维彩色多普勒经胸超声心动图对结构性心脏病术前评估的应用

Application of real-time three-dimensional color doppler transthoracic echocardiography on preoperative assessment of patients with structural heart disease

目的探讨实时三维彩色多普勒经胸超声心动图(RT-3D-CDTTE)在结构性心脏病(SHD)外科手术前评估应用中的可行性及诊断价值。方法应用RT-3D-CDTTE技术对111例患者进行术前评估,其中SHD患者31例,非SHD患者80例作为阴性对照,对比常规二维彩色多普勒经胸超声心动图(2D-CDTTE),以心血管造影和术中直视所见为"金标准",首先进行术前超声心动图检查及诊断,然后追踪造影及手术结果,以验证术前超声诊断的准确性。结果 (1)RT-3D-CDTTE能够在术前清晰显示SHD病变的三维结构及血流动力学状态,与心血管造影和术中直视所见基本一致。(2)2D-CDTTE对比"金标准"Mc Nemar检验的P值大于0.05,Kappa=0.654(P<0.001)。RT-3D-CDTTE对比"金标准"Mc Nemar检验的P值大于0.05,Kappa=0.932(P<0.001)。结论 RT-3D-CDTTE为SHD外科手术前评价及决策提供了重要信息。

Objective To investigate the diagnostic value of preoperative real-time three-dimensional color Doppler transthoracic echocardiography on assessment of patients with structural heart disease （SHD）. Methods A total of 111 pa？tients were assessed preoperatively using real-time three-dimensional color Doppler transthoracic echocardiography （RT-3D-CDTTE）, which include 31 SHD patients and 80 patients without SHD that were designed as negative control. Conven？tional two-dimensional color Doppler transthoracic echocardiography （2D-CDTTE） were used to compared with RT-3D-CDTTE while cardiovascular angiography and intraoperative findings were used as“Golden Standard”simultaneously. First of all, preoperative echocardiographic examination were performed and diagnosis was given. Angiography and intraoperative findings were hired to verify the accuracy of echocardiographic diagnosis before operation. Results （1） The preoperative RT-3D-CDTTE displayed three-dimensional structure and hemodynamic status of SHD cardiac lesions clearly, which were consistent with cardiovascular angiography and intraoperative findings. （2） P value of McNemar test between 2D-CDTTE and“Golden Standard”was greater than 0.05, Kappa=0.654 （P〈0.001）. P value of McNemar test between RT-3D-CDTTE and“Golden Standard”was greater than 0.05, Kappa=0.932 （P〈0.001）. Conclusion RT-3D-CDTTE can provides essen？tial information for preoperative evaluation which is important for decision of SHD management.