实时三维经食管超声心动图评估主动脉夹层

Real-time three-dimensional transesophageal echocardiography in assessment of aortic dissection

目的探讨实时三维经食管超声心动图(3D-TEE)评估主动脉夹层分型、判断是否累及主动脉根部及冠状动脉的价值。方法回顾性分析30例主动脉夹层患者的3D-TEE、二维经胸超声心动图(2D-TTE)、CTA检查结果,并与术中所见进行比较,计算3种成像方式对主动脉夹层分型诊断的符合率,以及3D-TEE、CTA诊断主动脉根部及冠状动脉受累的符合率。结果3D-TEE、CTA判断主动脉夹层DebakeyⅠ型、Ⅱ型、Ⅲ型的诊断符合率均为100%,2D-TTE的诊断符合率分别为76.47%(13/17)、80.00%(4/5)、75.00%(6/8);3D-TEE、CTA诊断累及冠状动脉的符合率分别为66.67%(4/6)、83.33%(5/6),诊断累及主动脉根部的符合率分别为100%(11/11)、72.73%(8/11)。结论实时3D-TEE可对主动脉夹层的范围、主动脉根部、冠状动脉等部位进行实时动态三维重建,为诊断主动脉夹层以及判断重要解剖结构受累情况提供影像学支持。

Objective To observe the value of real-time three-dimensional transesophageal echocardiography (3D-TEE) in diagnosing aortic dissection and evaluating coronary artery and aortic root involvement.Methods Data of 3D-TEE,two-dimensional transthoracic echocardiography (2D-TTE) and CTA in 30 patients with aortic dissection were retrospectively analyzed and compared with operative findings,and the accordance rate of the three techniques in classifying aortic dissection,as well as of 3D-TEE and CTA in assessment of aortic root and coronary artery involvement were evaluated.Results The diagnostic coincidence rate of 3D-TEE and CTA in classifying aortic dissection Debakey Ⅰ,Ⅱ,Ⅲ type were all 100%,of 2D-TTE in Debakey Ⅰ was 76.47%(13/17),in Debakey Ⅱ was 80.00%(4/5) and in Debakey Ⅲ was 75.00%(6/8).The coincidence rate of 3D-TEE in assessment of coronary artery involvement was 66.67%(4/6),and of CTA was 83.33%(5/6).The coincidence rate of 3D-TEE in assessment of aortic root involvement was 100%(11/11),and of CTA was 72.73%(8/11).Conclusion Real-time 3D-TEE can perform real-time dynamic three-dimensional reconstruction of aortic dissection,aortic root,coronary artery and other parts,and provide imaging support for diagnosis of aortic dissection and assessment of important anatomical structures.