经胸多平面探头三维重建及实时全容积三维超声心动图检测房间隔缺损的实验比较研究

目的探讨经胸多平面探头三维重建与实时三维超声心动图技术对房间隔缺损定性、定量的诊断价值.方法分别应用TTO探头及X4探头对15只离体猪心房间隔缺损模型进行采样后三维重建,以L1a、L2a剖视面对房间隔缺损进行观察;两种不同采样方式三维重建测量房间隔缺损长径、短径、面积与解剖实际测量值进行比较;同时比较两种三维技术在采样及重建及定性、定量分析时间过程中所耗时间.结果 TTO-3DE和RT-3DE均可显示缺损的形态、部位及与周边结构的毗邻关系,两种方法的超声测量值与实测值差异无显著性意义(P>0.05),且与实测值均具有良好相关性,TTO-3DE采样时间远远长于RT-3DE,但重建及定性、定量分析所耗时间无显著性差异.结论 TTO-3DE和RT-3DE能准确显示房间隔缺损的解剖结构信息,RT-3DE因其采样迅速、即时成像的特点,在指导外科手术和介入性治疗方面更具有实用意义.     

二维超声心动图显示房间隔缺损的平面图像

目的对缺损的大小和形态学特征的准确评估，是房间隔缺损（ASD）临床决策至关重要的信息；然而，二维超声心动图（2DE）常规切面难以显示ASD的整个缺损VI的形态，本研究探讨特殊的2DE切面显示ASD形态学特征的全貌和ASD与周边结构的空间关系。 方法2DE常规切面诊断237例成人继发孔型ASD，再使用房间隔切面显示ASD完整的平面形态学特征。比较任何一个常规切面测量的ASD最大直径和房间隔切面显示完整的ASD平面的情况下测量ASD最大直径。 结果220／237例（92．8％）患者使用胸骨旁房间隔切面成功地显示ASD的整个缺损平面，其中单个缺损口的194例患者，常规切面与房间隔切面显示的ASD最大直径的差异有非常显著的统计学意义（P〈0．001），2种方法测量的最大直径呈直线相关，相关系数有高度显著性（r=0．935，P〈0．001）。胸骨旁房间隔切面能显示ASD的大小、形状、边缘情况及与周边结构的空间关系，也能显示2个或2个以上缺损口之间的关系。 结论作者首次提出使用经胸2DE胸骨旁房间隔切面能清晰显示ASD完整的平面图像，提供ASD的大小、形状、位置及周边关系的信息，如此精确的显像对临床决策和确定是单个或多个缺损具有重要的意义。     

经胸超声心动图对房间隔缺损封堵术失败原因分析

目的 评价经胸超声心动图(TTE)在房间隔缺损(ASD)封堵术中的应用价值.方法 应用TTE术前检查继发ASD患者49例,确定ASD大小、形态及缺损周边残存房间隔的长度,观测有无分流及瓣膜异常.结果 41例患者封堵成功,ASD大小平均为(16.5±6.3)mm,封堵器大小平均为(18.5±8.3)mm,TTE测量大小与封堵器大小相关良好(P＜0.001),8例患者封堵失败.结论 TTE通过剑下双房矢状切面、大血管短轴切面及心尖四腔切面观察ASD及其周边结构,即可确保封堵术的成功.     

实时三维超声心动图在儿童继发孔型房间隔缺损封堵治疗中的应用研究

目的探讨经胸实时三维超声心动图评价小儿继发孔型房间隔缺损结构和封堵术后封堵器形态的临床应用价值。方法儿童继发孔型房间隔缺损患者10例，Amplatzer封堵器封堵术后患者9例。以Philips Sonos7500型超声仪，经胸分别以Live 3D和Full-Volume模式进行实时三维显示和重建。结果经胸Live 3D模式实时三维显示图像清晰，从不同的角度实时显示房间隔缺损和封堵器的三维结构。Full-Volume模式图像采集快速，重建图像清晰，所有图像均清晰显示房间隔缺损的大小、位置、周边残端结构和周边毗邻的解剖结构。结论经胸实时三维超声心动图清晰显示儿童房问隔缺损结构和封堵器的形态，对ASD封堵治疗具有重要的临床意义。     

三维超声仿真心腔内窥镜技术诊断房间隔缺损的实验研究

目的 探讨三维超声虚拟现实技术实现仿真心腔内窥镜观测房间隔缺损（ASD）的可行性。方法建立10个新鲜离体猪心ASD模型，经超声水槽用HP Sonos 5500超声系统采集三维超声图像，用移动立方体算法进行表面重建及可视化，建立心内三维超声仿真心腔内窥镜系统；同时将该系统的ASD面积、最大径和最小径测值与实测值进行比较。结果10例离体心ASD均成功获得虚拟显示。三维超声虚拟现实技术能够模拟心内视角显示缺损的形态、部位及邻近上腔静脉、下腔静脉间的关系，且与实际观察结果一致。测量三维重建并虚拟显示后的ASD面积、最大径和最小径，测得数据与实测值高度相关（r〉0．95，P〈0．01）。结论三维超声仿真心腔内窥镜技术为小儿先天性心脏病三维超声诊断提供了一种新方法。     

体元模型超声三维重建测量房间隔缺损大小的实验研究

为了评价三维体元模型超声重建法定量房间隔缺损的准确性，我们对１４个房间隔缺损的模型进行三维重建。结果显示：三维重法可明确显示缺损的形态，部位和邻近上腔静脉和下腔静脉间的关系，并与实际观察到的情况相一致。     

实时三维经食管超声心动图对特殊类型房间隔缺损治疗的风险评估

目的 评价实时三维经食管超声心动图（RT-3DTEE）在临床治疗特殊类型房间隔缺损（ASD）风险评估中的应用价值。方法 对57例特殊类型ASD患者分别通过二维经胸超声心动图（2DTTE）、二维经食管超声心动图（2DTEE）及RT-3DTEE进行术前评估。观察ASD相关声像图表现,并对比三者对临床治疗的指导作用。结果 57例特殊类型ASD中,采用2DTTE及2DTEE对46例可清晰显示ASD的形态和数目,对其余11例仅能诊断ASD为不规则或两孔可能,而RT-3DTEE对57例均可直观显示ASD形态和数目。采用2DTTE、2DTEE及RT-3DTEE测量收缩末期左心房横径（LATD）、右心房横径（RATD）、右心室舒张末期内径（RVDD）、左心室舒张末期内径（LVDD）差异均无统计学意义（P均>0.05）;测量ASD的最大径（ASDD）时,2DTEE与2DTTE、RT-3DTEE与2DTTE差异均有统计学意义（P均<0.05）。3种方法测量ASD上腔静脉侧、主动脉侧及心房顶侧的残边长度总体差异均无统计学意义（P均>0.05）;3种方法测量ASD下腔静脉侧残边长度总体差异有统计学意义（F=50.39,P<0.001）,两两比较差异均有统计学意义（P均<0.05）。通过RT-3DTEE对57例均可指导ASD治疗方式,而2DTTE对5例不能确定,2DTEE对2例不能确定。结论 RT-3DTEE可提供丰富的影像诊断信息,对特殊类型ASD治疗的风险评估具有重要指导意义。     

各种测量房间隔缺损方法在房间隔缺损治疗中的价值比较

目的　对房间隔缺损 (ASD)患者采取经胸壁二维超声心动图 (TTE)、经食道动态三维重建、球囊导管及开胸测量缺损直径并相比较 ,评价各种测量ASD方法在ASD治疗中的价值。方法　 46例患者均接受TTE检查和经食道动态三维重建。 ( 1)对 3 0例适宜Amplatzer封堵治疗的患者 ,将重建所得ASD最大直径、TTE最大直径和球囊导管测量直径相比较 ,并且ASD重建最大直径、TTE最大直径分别与球囊导管测量直径行相关分析。 ( 2 ) 16例不适宜封堵的患者 ,将重建所得的ASD最大直径与TTE及开胸测量缺损最大直径相比较。结果　ASD直径的TTE、三维重建测量值与球囊测量值相比较有差别 ,但两者与球囊测量值均相关良好。三维重建与球囊测量值回归方程的标准误差较小。TTE测量值与开胸测量值相比较无差别 (P >0 .0 5 ) ,但经食道超声心动图三维重建测量值与开胸测量值相比较有差别 (P <0 .0 5 ) ,大于开胸测量值。结论　TTE可以作为ASD的筛查方法 ,而经食道超声心动图三维结构重建测值则可作为选择ASD治疗方案以及封堵器大小的重要参考。对于采取开胸手术的患者 ,于术前仅行TTE检查即可     

四维超声心动图显示房间隔缺损的临床研究

为了观察房间隔缺损解剖病变的立体结构关系，对１５例正常人和１８例房间隔缺损患者的房间隔及其心内血流分流信号进行了四维（动态三维）超声心动图重建。结果表明：四维超声心动图能直观逼真地展现房间隔解剖结构的立体特征，对其毗邻结构上、下腔静脉、三尖瓣、主动脉等及相互间的解剖关系也能清晰显示。从右房或左房侧面对房间隔进行观察，正常房间隔结构完整；房缺时，见房间隔上有缺孔，其形状、大小、数目、与毗邻解剖结构的关系显示清晰并可观察实时活动。对血流分流信号进行四维重建，可显示分流束的立体形态及动态变化。部分病例术中修补后重建见房间隔完整。研究表明四维超声心动图能观察房间隔缺损解剖病变的立体形态及动态变化，较两维超声心动图能更准确地区分缺损类型、测量缺损大小。并能协助制定治疗方案及评价疗效     

彩超诊断心内膜垫缺损2例

例 1,女 ,4岁 ,先天愚型 ,发育迟缓 ,消瘦。体检 :心前区隆起 ,心率 98次 /分 ,律齐。胸骨左缘第3、 4肋间闻及 3/ 6级收缩期杂音。彩超所见 :心尖四腔切面图显示房间隔下部及室间隔膜部缺损 (图 1) ,二尖瓣与三尖瓣分别有腱索连接于室间隔上端 ,二尖瓣、三尖瓣分开 (图 2 ) ,RA 3.1cm,RV 2 .8cm,ASD示房间隔原发孔型缺损 ;VSD示室间隔膜部缺损图 1　收缩期心尖四腔切面图共同房室瓣由二尖瓣 (MV标示 )和三尖瓣 (TV标示 )组成 ,二、三尖瓣分开图 2　舒张期心尖四腔切面图RVOT3.0 cm,RVAW0 .5 8cm,主、肺动脉关系正常 ,AO1.1cm,m P…     

实时三维、多平面二维经食管超声心动图在房间隔缺损测量的对比研究

目的比较实时三维、多平面二维经食管超声心动图在房间隔缺损（atrial septal defect, ASD）测量的应用价值。 方法对67例继发孔型房间隔缺损患者分别应用经食管二维超声常规切面法、经食管二维超声十二切面法、实时三维经食管超声法进行测量,并将各测量结果与封堵器大小行相关性分析。 结果经食管二维超声常规切面法在整体（P < 0.001）、大ASD组（P < 0.001）、椭圆形ASD组（P < 0.01）测量ASD最大径小于实时三维经食管超声法,差异有统计学意义;经食管二维超声十二切面法在小ASD组（P < 0.05）测量ASD最大径大于实时三维经食管超声法,差异有统计学意义;实时三维经食管超声法测量房间隔缺损最大径与封堵器大小的相关性高于经食管二维超声常规切面法及十二切面法。 结论实时三维经食管超声可准确测量房间隔缺损,对封堵器选择有重要指导作用。经食管二维超声十二切面法可与实时三维经食管超声法互为补充。       

正常成年人上腔静脉的二维超声检测

目的探讨上腔静脉(SVC)最佳超声检测途径,获取较客观的SVC形态学指标。方法对随机选取的56例健康志愿者行经右锁骨上窝及心尖五腔、剑下四腔切面基础上的SVC超声探查,测量平静呼吸状态下各切面SVC内径及可见长度。结果56例受试者右锁骨上窝、胸骨旁心尖五腔及剑下四腔切面SVC显示率分别是,96.43%、89.3%、82.1%,显示长度分别是(56.49±7.91)mm、(28.29±5.83)mm、(22.05±4.37)mm。吸气相内径分别是(16.00±2.11)mm、(13.71±2.34)mm、(11.43±2.05)mm,呼气相内径分别是(9.41±1.63)mm、(8.91±1.78)mm、(6.61±1.14)mm。结论右锁骨上窝切面及心尖五腔切面SVC显示满意率较高,可对SVC行全程检测。SVC内径随呼吸周期呈规律性变化。     

Clinical advantage of real-time three-dimensional transesophageal echocardiography for transcatheter closure of multiple atrial septal defects

This study sought to evaluate the usefulness of real-time three-dimensional (3D) transesophageal echocardiography (TEE) to guide the repair of multiple atrial septal defects (ASDs). Of 212 consecutive patients with secundum ASD who were scheduled for transcatheter closure of their ASDs, 27 had multiple ASDs. These patients underwent two-dimensional (2D) transthoracic echocardiography, 2D TEE, and 3D TEE. Overall, 18 patients had two defects, and 9 patients had three or more defects. The latter group included three patients with multi-fenestrated defects. Optimal 3D images were obtained in 93 % of the patients. In patients with two defects, information on the positional relation of the defects was obtained using 2D TEE and 3D TEE in 71 and 94 % of patients, respectively (P = 0.22). The positional relations of the defects could not be evaluated with 2D TEE in patients with three or more defects, whereas it could be evaluated with 3D TEE in all of these patients (0 vs. 100 %, P = 0.008). In all patients, 3D TEE proved superior to 2D TEE for providing sufficient information (96 vs. 48 %, P = 0.002). Procedural success was obtained in 26 patients (96.3 %), without complications. Transcatheter closure of multiple ASDs under 3D TEE guidance is effective and safe. Real-time 3D TEE can provide useful information regarding complex ASD morphology. It can thus contribute to developing a successful treatment strategy, especially in patients with three or more defects.     

Evaluation of mitral valve prolapse using newly developed real-time three-dimensional echocardiographic system with real-time volume rendering

The development of a real-time three-dimensional (RT3D) image acquisition system and direct digital links between ultrasound equipment and the data processing computer facilitate improved 3D image reconstruction. However, at present time, it is hard to promptly display 3D images and is also ineffective for a practical use. The objective of this study was to assess the feasibility of a new transthoracic RT3D echocardiographic system for evaluation of mitral valve prolapse. Eighteen patients with mitral valve prolapse diagnosed by transthoracic two-dimensional (2D) echocardiography and M-mode were examined through this technique (11 male, mean age 42 ± 17 years). Since visualization of mitral valve from apical four-chamber view was better than that of the parasternal approach, only apical approach was used for mitral valve evaluation. This system is capable of acquiring volumetric data from mechanical scanning of the phased-array transducer (3.5 MHz) as well as displaying the volume rendered images of the structure without storing the image data and reconstruction of the object. The prolapse of leaflet could be seen in 14/18 (77%) of patients with mitral valve prolapse based on conventional echocardiography. The newly developed transthoracic RT 3D ultrasound system without a reconstruction process seemed to be a useful noninvasive tool for diagnosis of mitral valve prolapse and detection of prolapsed leaflet or scallop, which is very important for deciding on a reliable surgical technique.     

Three-Dimensional Echocardiography in Adult Patients: Comparison Between Transthoracic and Transesophageal Reconstructions

BACKGROUND: Three-dimensional (3D) echocardiography is a relatively new technique typically implemented with transesophageal imaging with multiplane transducers. OBJECTIVES: The goals of this study were (1) to test the feasibility of 3D reconstruction with a new transthoracic multiplane transducer in adult subjects with excellent quality of 2-dimensional images and (2) to compare these reconstructions with those obtained in the same patients with the transesophageal approach. METHODS: Transthoracic multiplane image acquisition was performed in 37 patients who were selected on the basis of the quality of their 2-dimensional images. In addition, transesophageal acquisition was also performed in 19 of 37 patients. Three-dimensional reconstruction of mitral and aortic valves was performed. Three-dimensional images were reviewed, and the visualization of various anatomic features was graded. RESULTS: The reconstruction of 25 mitral valves and 16 aortic valves, normal and pathologic, was feasible and resulted in visualization of anatomic detail. Score indexes of all valvular characteristics studied were not significantly different when transthoracic and transesophageal reconstructions were compared. CONCLUSIONS: Transthoracic 3D echocardiography with a multiplane transducer in adult patients with good acoustic windows is feasible. This technique will allow easy noninvasive serial assessment of valvular pathophysiologic characteristics.     

Assessment of the corpus callosum at 20-24 weeks' gestation by three-dimensional ultrasound examination.

OBJECTIVES: To determine the range of positions of the fetal head in which a three-dimensional (3D) volume is acquired for subsequent successful imaging of the corpus callosum. METHODS: We used 3D volumes of the fetal head obtained from singleton pregnancies at 20 to 23 + 6 weeks' gestation. The volumes, which had been acquired with the head in different positions, were then reconstructed with the objective of obtaining a mid-sagittal section of the brain to demonstrate the presence of the corpus callosum. RESULTS: In the reconstructed mid-sagittal sections it was possible to demonstrate the corpus callosum in at least 90% of cases when the 3D volume acquisition plane was (1) mid-sagittal with the angle between the transducer and the direction of the fetal nose ranging from 0 degrees to 179 degrees and from 330 degrees to 359 degrees , (2) oblique around the crown-rump axis with an angle from the mid-sagittal plane of less than 30 degrees , (3) oblique around the anteroposterior axis from the axial plane at the level of the biparietal diameter to the mid-sagittal plane or (4) axial at the level of the biparietal diameter with an angle between the transducer and the midline echo of the brain of 60-119 degrees . In the mid-sagittal sections either the translucent corpus callosum or a comma-shaped echogenic structure was seen depending on whether the plane of volume acquisition was sagittal or axial. CONCLUSIONS: In 3D ultrasound examination the extent to which the corpus callosum can be demonstrated to be present is entirely dependent on the plane of volume acquisition.     

Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates

Objectives: The aim of the present study was to establish the accuracy and reproducibility of left atrial volume measurements by three-dimensional (3D) echocardiography compared to 2D biplane and monoplane measurements. Background: No echocardiographic technique is generally accepted as optimal for estimation of left atrial size. Methods: Left atrial volumes of 18 unselected cardiac patients were obtained with magnetic resonance imaging (MRI) (volumes 145 ± 58?ml). These volumes were compared with those obtained with different echocardiographic methods: a multiplane 3D method based on 90 images acquired by apical probe rotation, a simplified 3D method using only the three standard apical views, and 2D biplane and monoplane methods based on area-length, disc summation and spherical formulas. Results: The echocardiographic methods significantly underestimated maximum left atrial volumes as obtained by MRI by 14–37% (p < 0.001). Accuracy, expressed as 1 SD of individual estimates around this systematic underestimation, was 25 to 27% for all methods, except for the 2D 2-chamber monoplane method (37%). Interobserver coefficient of variation was between 14 and 20% for all methods (n.s.). Conclusion: All echocardiographic methods significantly underestimated left atrial volumes as obtained by MRI. A minor non-significant improvement in individual echocardiographic estimates by the 3D methods was obtained at the cost of more time consumption. In unselected patients ultrasound image quality precludes significant improvement of left atrial volume measurements by the applied 3D methods.