经食管实时三维超声心动图对三尖瓣环形态的研究

The study of forms of tricuspid annulus by real-time 3-dimensional transesophageal echocardiography

目的:应用经食管实时三维超声心动图(RT-3D-TEE),结合QLAB后处理分析软件对比分析右心室收缩功能减低患者的三尖瓣环形态变化。方法:收集少量或者无三尖瓣反流患者15例,作为对照组;有中-重度三尖瓣反流患者23例,作为反流组;将有中-重度三尖瓣反流患者按照右心室射血分数(RVEF)进行分组,RVEF≥50%,12例;RVEF≤45%,11例。所有患者均行经食管实时三维超声心动图检查,获取全容积图像,应用QLAB后处理分析软件的MVQ技术手动描记三尖瓣环,获得三尖瓣环最大投影面积、最大周长、最大高度、最大瓣环左右径及前后径、投影面积变化率、周长变化率。结果:1对照组与反流组间有明显变化,瓣环最大投影面积及最大周长、瓣环最大左右径及前后径、最大投影面积变化率、最大周长变化率及瓣环高度差异均有统计学意义(P<0.05);2在反流组内,右心室收缩功能减低组与右心室收缩功能正常组间,瓣环最大投影面积及最大周长、瓣环最大左右径及前后径、最大投影面积变化率、最大周长变化率及瓣环高度没有差异,差异无统计学意义(P>0.05)。结论:经食管实时三维超声心动图结合分析软件能定量评价三尖瓣环形态及运动变化规律,严重三尖瓣反流较正常对照组的瓣环结构发生变化,严重三尖瓣反流组内右心功能减低与右心功能正常的患者三尖瓣环结构没有明显变化。

Objective：Contrastive analysis the forms and functions of tricuspid annular in patients with right ventricular systolic function reduced by Real-time three-dimensional transesophageal ultrasound （ RT-3D- TEE） combined with the QLAB post-processing analysis software. Methods： Select no or a small amount of 15 patients with tricuspid regurgitation, as a control group ; severe tricuspid regurgitation in 23 patients, as a regur- gitation group; according to right ventricular ejection fraction （ RVEF）, RVEF 50% or higher, 12 cases; RVEF 45% or less, 11 cases, All patients through esophagus real-time three-dimensional echocardiography, Learn from full volume image, application of MVQ technical of QLAB analysis software, automatic receive the largest projected area of the tricuspid annulus, the largest perimeter, maximum height, maximum diameter and the annulus around the anteroposterior diameter, change rate of projected area, change rate of perimeter. Re- sults ： （ 1 ） Relative to the control group, the largest annulus projected area and maximum perimeter and the lar- gest annulus diameter and the anteroposterior diameter increase in the regurgitation group, maximum projected area and the largest circumference of the rate of change rate of change,which have statistically significant （ P 〈0. 05 ）. （2） IN regurgitation group, between the two group, all parameters were not statistically significant （P 〉 0. 05）. Conclusion ：Transesophaeal real-time three-D ultrasound can quantitatively evaluate the changes of tricuspid annular motion and movement rule. Tricuspid annular shape have taken place significant changes in Severe tricuspid regurgitation contrast the normal control group ; severe tricuspid regurgitation group right heart function to reduce and right heart function in patients with normal tricuspid ring structure have no obvious change. IN severe tricuspid regurgitation group, the reduced right heart function and normal right heart function in patients tricuspid ring structure have no obvious change.