实时三维经食管超声心动图评价房间隔缺损动态变化特征

目的 探讨实时三维经食管超声心动图(RT-3D TEE)评价房间隔缺损(ASD)的大小、形态及边缘等随心动周期的动态变化特征及其影响因素.方法 对20例继发孔型ASD患者(20个ASD)分别应用二维经食管超声心动图(2D-TEE)及RT-3D TEE测量ASD的最大径,并与经皮导管球囊充盈测量直径(stretched balloon diameter,SBD)或开胸手术测值进行相关分析.通过实时三维3D-Zoom获得ASD三维外科医生观,观察RT-3D TEE状态下ASD的形态、边缘及毗邻等随心动周期的变化特征.测量RT-3DTEE状态下的ASD面积和最大径在心动周期不同时相的数值,计算最大面积变化率和直径变化率,并利用多元线性回归逐步分析法分析其影响因素.结果 ①RT-3D TEE所见的ASD形状在收缩末期时常表现为类圆形或椭圆形,舒张末期时常表现为不规则形或椭圆形.②RT-3D TEE所测ASD的面积和最大径在等容收缩期时最小,等容舒张期时最大,最大径与SBD的相关系数为0.962,优于2D-TEE所测ASD最大径与SBD的相关系数(0.820).③RT-3D TEE所测得的ASD的面积变化率为11.48%～71.12%,最大径变化率为2.8%～43.87%,两者间的相关系数为0.879.结论 RT-3D TEE能实时、直观、清晰、完整地显示ASD随着心动周期而呈周期性变化的特征,弥补2D-TEE视角上的缺陷,为经皮导管球囊介入术和开胸手术治疗术前提供完整的信息.

Abstract：

Objective To determine whether real-time three-dimensional transesophageal echocardiography(RT-3D TEE) is an accurate non-invasive technique for defining the morphology of atrial septal defects(ASD). Methods In 20 patients with secundum ASD, mean age 42.2 years (7 male, 13 female) ,live three dimensional surgical views of ASD were acquired,qualitative morphology of ASD such as the shape, presence of fenestrations and the defect margins were noted during the cardiac cycle. The measurements obtained from 2-dimensional transesophageal echocardiography(2D-TEE) and RT-3D TEE were compared to those obtained from stretched balloon diameter(SBD) or surgery. Measurements of the size and area change of ASD were validated during the cardiac cycle by RT-3D TEE,stepwise multiple linear regression analysis was performed to test the correlation between the maximum change ratios of area and diameter of ASD and age, atrial septal length, ASD shunting velocity, the maximum diameter of ASD and right ventricular systolic pressure. Results ① The morphology of ASD was circle-like or elliptical in systole,irregular or elliptical in diastole. ②The area and diameter of ASD measured by RT-3D TEE was minimal in isovolumetric contraction phase, maximal in isovolumetric diastole phase. The correlation coefficient of maximum diameter measured by 3D with SBD was 0.962 , greater than that by 2D and SBD (0.820). ③The change ratio of area and maximum diameter of ASD acquired by RT-3D-TEE was 11.48%-71.12% and 2.80%-43.87% respectively,and the correlation coefficient of them was 0.921. Conclusions RT-3D TEE using live 3D-Zoom mode accurately displayed the varying morphology,dimensions and spatial relations of ASD. RT-3D TEE can offer visualization morphological changing of ASD in different periods of cardiac cycle,providing more information for percutanous catheter intervention and open heart surgery.

Evaluation of dynamic morphology of atrial septal defect by real-time three-dimensional transesophageal echocardiography

Objective To determine whether real-time three-dimensional transesophageal echocardiography(RT-3D TEE) is an accurate non-invasive technique for defining the morphology of atrial septal defects(ASD). Methods In 20 patients with secundum ASD, mean age 42.2 years (7 male, 13 female) ,live three dimensional surgical views of ASD were acquired,qualitative morphology of ASD such as the shape, presence of fenestrations and the defect margins were noted during the cardiac cycle. The measurements obtained from 2-dimensional transesophageal echocardiography(2D-TEE) and RT-3D TEE were compared to those obtained from stretched balloon diameter(SBD) or surgery. Measurements of the size and area change of ASD were validated during the cardiac cycle by RT-3D TEE,stepwise multiple linear regression analysis was performed to test the correlation between the maximum change ratios of area and diameter of ASD and age, atrial septal length, ASD shunting velocity, the maximum diameter of ASD and right ventricular systolic pressure. Results ① The morphology of ASD was circle-like or elliptical in systole,irregular or elliptical in diastole. ②The area and diameter of ASD measured by RT-3D TEE was minimal in isovolumetric contraction phase, maximal in isovolumetric diastole phase. The correlation coefficient of maximum diameter measured by 3D with SBD was 0.962 , greater than that by 2D and SBD (0.820). ③The change ratio of area and maximum diameter of ASD acquired by RT-3D-TEE was 11.48%-71.12% and 2.80%-43.87% respectively,and the correlation coefficient of them was 0.921. Conclusions RT-3D TEE using live 3D-Zoom mode accurately displayed the varying morphology,dimensions and spatial relations of ASD. RT-3D TEE can offer visualization morphological changing of ASD in different periods of cardiac cycle,providing more information for percutanous catheter intervention and open heart surgery.