实时三维超声心动图在经皮导管闭合房间隔缺损介入治疗前后的初步应用

Preliminary application of transthoracic real-time three-dimensional echocardiography to pre-and post-percutaneous transcatheter closure of atrial septal defect

目的 探讨实时三维超声心动图评价经皮导管封堵先天性心脏病房间隔缺损 (ASD)的应用价值。方法 应用实时三维超声心动图对 11例ASD患者术前进行缺损大小、形态、位置及术后对封堵器的形态、位置、塑型及大小进行观察 ,应用全容积三维超声重建进行测量 ,并与二维超声心动图和手术结果比较。结果 术前实时三维超声心动图显示继发孔ASD位置均为中央型 ,缺损形态多为椭圆形 ;测量ASD长径与二维超声心动图比较差异有显著性意义 (P <0 .0 5 ) ,短径、缺损边缘距二尖瓣环的距离、距心房顶部的距离与二维超声心动图比较差异无显著性意义。术后实时三维超声心动图显示封堵器呈双盘状 ,表面无异常回声附着 ,2例封堵器伞盘随心脏舒缩运动变化 ,9例无变化 ;测得封堵器伞腰直径与实际封堵器大小比较差异无显著性意义 (P >0 .0 5 ) ;二维超声心动图测得的缺损口最大径与实际封堵器大小和三维超声心动图测值比较差异有显著性意义 (P <0 .0 5 ) ,但与封堵器大小相关性好 (r =0 .83 ,P <0 .0 5 )。结论 实时三维超声心动图成像速度快 ,可作为介入治疗术前指导、术后评价疗效的重要手段。

Objective To explore the clinical value of real-time three-dimensional echocardiography (RT-3DE) in percutaneous transcatheter closure treatment of atrial septal defect (ASD). Methods The sizes,shapes and sites of ASD were visualized by RT-3DE and measured by full volume rendered three-dimensional echocardiography (3DE) before operation and after closure operation in 11 ASD patients,and compared with those from two-dimensional echocardiography(2DE) and the operation. Results Before the operation,RT-3DE visualization showed that the secundum ASD′s sites of the 11 patients were central and shapes were mostly ellipse. In this study a significant difference was found in the measurements of long distances of ASD between 3DE and 2DE [( 28.9 ± 8.2 )mm vs ( 20.0 ± 7.3 )mm,P < 0.05 ],other indexes such as short distances of ASD,defect edge to atrial dome and to annulus of mitrial valve obtained by 3DE were not significantly different from those obtained by 2DE. The occluder devices were showed clearly by RT-3DE post -operation. The devices without abnormal echo attached were shaped like double-disk. The devices of 2 patients moved with cardiac cycles,the other patients were free from this phenomena. No significant difference was found between the connecting waist diameters of occluder measured by 3DE and the actual ones[( 24.4 ± 4.6 )mm vs ( 25.1 ± 4.1 )mm,P > 0.05 ]. Maximal diameters of defects measured by 2DE[( 21.1 ± 3.5 )mm,P < 0.05 ] were different from those of the actual devices and those by 3DE significantly,but correlated well to the actual ones ( r = 0.83 ,P < 0.05 ). Conclusions RT-3DE has high frame rate and can be used as an important method for both the guidance of pre-occlusion treatment and the assessment of clinical effects in post-treatment.