实时三维经食管超声心动图测定房间隔缺损最大径的价值评估

目的:探讨实时三维经食管超声心动图(real-time three-dimensional transesophageal echocardiography,RT3DTEE)在测量房间隔缺损(atrial septal defect,ASD)最大径中的应用价值。方法:前瞻性分析2011年1月至2014年6月单中心筛查的继发孔中央型单孔ASD并接受封堵术患者的临床资料。比较RT3D-TEE、二维经胸超声心动图(two-dimensional transthoracic echocardiography,2D-TTE)、二维经食管超声心动图(two-dimensional transesophageal echocardiography,2DTEE)测得的ASD最大径,并将三者与封堵器释放后的实际腰部直径进行相关性分析。结果:共31例患者入选,经RT3DTEE[(21.81±8.57)mm]、2D-TEE[(20.31±8.50)mm]、2D-TTE[(23.08±10.89)mm]测得的缺损最大径与封堵器释放后实际腰部直径[(20.99±8.15)mm]比较,差异均无统计学意义。经RT3D-TEE、2D-TEE、2D-TTE测得的缺损最大径与实际腰部直径均高度相关,相关系数(r值)分别为0.902、0.981、0.897(P=0.000)。结论:RT3D-TEE在测定ASD最大径方面较二维超声并无明显优势。

Quantitative study of maximal atrial septal defect diameter using real time three-dimensional transesophageal echocardiography

Objective The accurate measurement of atrial septal defect (ASD) diameter is vital to succeed in the transcatheter closure. Real-time three dimensional transesophageal echocardiography (RT3D-TEE) is a new imaging method which could provide three-dimensional high-quality images of ASD in theory. Therefore, it should be more accurate than other conventional methods. The study was aiming to determine the usefulness of RT3D-TEE for measuring the maximal ASD diameter by means of method comparison. Methods The maximal ASD diameters measured by RT3D-TEE, two dimensional transesophageal echocardiography (2D-TEE) and two dimensional transthoracic echocardiography (2D-TTE) were compared. Regression analysis was used to compare the maximal ASD diameters by three methods and occluder waist diameter (OWD) after release. Results A total of 31 ASD patients were included. The maximal septal diameters measured using RT3D-TEE, 2D-TEE and TTE were 21.81±8.57mm, 20.31±8.5mm and 23.08±10.89mm respectively. The OWD was 20.99±8.15mm.There was no statistically significant difference between the average maximal ASD diameters of these four groups or every two groups (all P>0.05). The maximal ASD diameters measured with RT3D-TEE, 2D-TEE and TTE manifested excellent correlations with the OWD (r=0.902, 0.981, 0.897 respectively, all P=0.000). Conclusion This study has demonstrated that RT3D-TEE has no advantages toward 2D echocardiography on measuring the maximal ASD diameter.