先天性心脏病三维超声虚拟内窥镜可视化研究

目的 研究开发三维心脏超声虚拟内窥镜系统并对先天性心脏病进行可视化研究.方法 正常小儿10例、先天性心脏病患儿22例(房间隔缺损10例,室间隔缺损6例,法洛四联症6例),将计算机虚拟现实技术和科学计算可视化技术结合,使用C++6.0语言编写和可视化工具库(VTK)开发平台对心脏超声数据集进行三维重建,创建虚拟现实环境系统,建立三维超声虚拟心脏,通过心内导航实现虚拟心内漫游.结果 三维心脏超声虚拟内窥镜系统实现了心脏超声数据的心内三维可视化和心内导航.结论 三维心脏超声虚拟内窥镜系统为先天性心脏病的诊断提供了一种新的可视化方法.     

应用虚拟现实技术对室间隔缺损三维超声诊断的实验研究

目的应用虚拟现实(VR)技术,实现室间隔缺损(VSD)的心内三维超声虚拟现实诊断.方法建立10个新鲜离体猪心VSD模型,采集三维超声图像进行三维重建和可视化,建立心内三维超声VR系统.结果应用VR技术后,显示缺损的形态、部位、数目和邻近解剖结构间的关系,均与与解剖后观察结果一致.测量三维重建并虚拟显示后的VSD面积、最大径和最小径,结果测得数据与实测值高度相关(r＞0.95,P＜0.01).结论 VR为小儿先天性心脏病三维超声诊断提供了一种新方法.     

心脏三维超声虚拟内窥镜系统导航与介入方法研究

目的通过心脏三维超声虚拟内窥镜系统导航和介入方法研究,旨在探索并建立复杂型先心病虚拟现实环境下观察的规范化"路径"和介入方法。方法采用体绘制技术重建心腔内表面的三维图像,并置感兴趣的心内结构于可视化显示窗中心,键盘操作与人工导航结合使三维重建图像沿着视线方向前进,产生被观察心内结构目标不断靠近观察者和放大的多帧图像。结果系统通过控制鼠标、键盘立体定位,结合VanPraagh"节段分析法"对感兴趣区域观察,使操作者在虚拟心脏内漫游,实现部分心内畸形结构的诊断。对诊断房、室间隔缺损者,应用虚拟介入装置模拟ASD、VSD介入治疗。结论三维超声虚拟内窥镜为先天性心脏病临床诊断、术前模拟介入、手术计划、外科手术导航及计算机辅助医学教学提供了一种新方法。     

基于等值面重建的心脏超声虚拟显示技术研究

目的 探讨基于等值面的三维重建和显示技术及其在诊断小儿先天性心脏病中的应用。方法 采集正常小儿心脏的超声图像进行重建和可视化，并做了30例房室隔缺损的离体动物心脏实验。结果 给出了正常小儿心脏的三维可视化结果，并在动物实验中对实际缺损和虚拟结果进行了对比。结论 本文所讨论的超声图像三维心脏重建和显示技术对婴儿复杂型先天性心脏病的诊断具有一定的帮助。     

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。     

超声心动图在小儿先天性心脏病手术中的应用研究

目的　探讨超声心动图技术在小儿先天性心脏病手术中的应用。方法　在4 2例小儿先天性心脏病手术中,于心内结构修复完成后行超声检查,其中经食管超声心动图( TEE) 3 4例,经心外膜超声心动图( EE) 8例。结果　根据超声检查结果,3例患儿因中-重度二尖瓣返流、1例因房水平残余分流、1例因肺动脉瓣下狭窄,重新转机修复心内结构;1例因左室后下壁心肌缺血,再次转机辅助循环。所有患儿术后无超声检查相关并发症发生。结论　TEE与EE结合应用于小儿先天性心脏病手术中,有重要的应用价值,且具有安全、高效的特点     

小儿先天性心脏病复杂畸形诊断中超声心动图的价值分析

目的:研究并探讨超声心动图在小儿先天性心脏病复杂畸形诊断中的应用价值。方法:研究对象选择2015年1月~2017年10月期间我院接收的50例小儿先天性心脏病复杂畸形患儿,所有患儿均接受多层螺旋CT(Multislice spiral CT,MSCT)、超声心动图、数字减影血管造影(digital subtraction angiography,DSA)检查,以手术诊断结果为金标准,计算和比较MSCT、超声心动图、DSA对先天性心脏病患儿复杂畸形的诊断准确率,并分析MSCT、超声心动图诊断结果与DSA诊断结果之间的一致性。结果:MSCT、超声心动图、DSA对先天性心脏病患儿心内畸形的诊断准确率比较无统计学意义(P0.05);MSCT、超声心动图对先天性心脏病患儿心外畸形的诊断准确率比较无统计学意义(P0.05),而DSA诊断准确率高于MSCT、超声心动图(P0.05)。MSCT、超声心动图与DSA诊断结果之间的一致性均较良好,而对于心外畸形的诊断结果一致性较差。结论:在小儿先天性心脏病复杂畸形诊断中,采用超声心动图检查可准确检出心内畸形,对心内结构予以清晰显示,但其对心外畸形的诊断准确性尚有待提高,可联合多层螺旋CT进行综合诊断。     

实时三维经食管超声心动图的临床应用研究

目的 探讨实时三维经食管超声心动图临床应用的可行性及价值.方法 应用实时三维经食管超声心动图对59例不同类型心脏病患者进行检查或术中监测,其中心律失常20例,瓣膜病变24例,先天性心脏病12例,主动脉夹层2例,不明原因肺动脉高压1例.结果 所有患者均成功完成实时三维经食管超声心动图检查或术中监测,能清晰显示正常心内结构及病变的三维图像,成像质量好,分辨力高.结论 实时三维经食管超声心动图安全可靠,可用于经胸声窗不佳者及术中监测,补充经胸实时三维超声的不足,在术中应用时不干扰手术野及手术进程,具有良好的临床应用价值.     

实时动态三维超声成像技术在产前筛查胎儿先天性心脏病中的应用

目的分析实时动态三维超声成像技术在产前筛查胎儿先天性心脏病中的应用价值。方法对280例具有高危因素的孕妇进行二维和实时动态三维超声成像技术检查。比较两种检查方法四腔切面、五腔切面、三血管气管切面及肺动脉切面显示率的差异,比较两种检查方法对胎儿先天性心脏病的敏感性差异。结果应用实时动态三维超声成像技术五腔切面、三血管气管切面及肺动脉切面的显示率显著高于二维超声法(P0.05)。四腔切面显示率与二维超声比较差异未见统计学意义(P0.05)。应用实时动态三维超声成像技术对先天性心脏病的敏感度略优于二维组(P0.05)。结论实时动态三维超声成像技术能更为清晰地提供胎儿复杂先天性心脏病立体三维显示,有助于为先天性心脏病产前筛查提供更可靠的诊断信息。     

胎儿心脏超声筛查在先天性心脏病检测中的应用分析

探讨胎儿心脏超声筛查在先天性心脏病检测中的效果。选取2000例孕妇进行研究,实施胎儿心脏超声筛查。发现1982例经超声心动图显示心内结构和心脏位置正常,18例心内结构异常,占0.9%。经证实,采用胎儿心脏超声检查的准确率为100%。另外,在正常胎儿出生后,2例在心脏听诊时出现杂音,经超声检查确诊为先天性心脏病,漏诊率为0.1%。采用心脏超声检查是诊断胎儿先天性心脏病的有效方法,具有无辐射、无损害等特点,可以有效观察心脏和血管之间的联系,对提高临床诊断率具有非常重要的意义。     

A review of the complementary information available with cardiac magnetic resonance imaging and multi-slice computed tomography (CT) during the study of congenital heart disease

The incidence of congenital heart disease is approximately 4–6 per 1000 new births; however, the number of people living with congenital heart disease (CHD) is increasing, because of improved diagnosis, medical, and surgical management. While echocardiography continues to be the mainstay of non-invasive imaging, cardiac MRI (cMRI) and computed tomography (CT) have taken on increasing roles in the diagnosis of congenital heart disease in infants, children, and importantly, adults who may have limited echocardiographic windows, especially if post-operative. Cardiac MRI and multi-slice CT can complement the diagnostic information obtained by echocardiography and invasive cardiac catheterization. Post-operative imaging of CHD is especially enhanced by the spin echo MRI techniques, while gradient cine echo MRI imaging allows functional information that is not encumbered by geometric assumptions. Phase contrast (velocity encoding) cardiac MRI data can provide information about flow, allowing accurate determination of regurgitation and shunt volume. Gadolinium enhanced cMRI or three-dimensional reconstructed images from multi-slice CT angiography allow excellent delineation of vascular structures in complex heart disease. Coronary imaging, while possible with both modalities, appears more facile with fast CT imaging. This article reviews the literature to provide an assessment of the special techniques and considerations needed during the conduct of cardiac MRI/MRA and multi-slice CT examinations during the diagnosis of congenital heart disease in pediatric and adult patients.     

Stereoscopic virtual reality does not improve knowledge acquisition of congenital heart disease

Advances in virtual reality have made it possible for clinicians and trainees to interact with 3D renderings of hearts with congenital heart disease in 3D stereoscopic vision. No study to date has assessed whether this technology improved instruction compared to standard 2D interfaces. The purpose of this study was to assess whether stereoscopic virtual reality improves congenital heart disease anatomy education. Subjects in a prospective, blinded, randomized trial completed a pre-test assessing factual and visuospatial knowledge of common atrioventricular canal and were randomized to an intervention or control group based on their score. The intervention group used a 3D virtual reality (VR) headset to visualize a lecture with 3D heart models while the control group used a desktop (DT) computer interface with the same models. Subjects took a post-test and provided subjective feedback. 51 subjects were enrolled, 24 in the VR group & 27 in the DT group. The median score difference for VR subjects was 12 (IQR 9–13.3), compared to 10 (IQR 7.5–12) in the DT group. No difference in score improvement was found (p?=?0.11). VR subjects’ impression of the ease of use of their interface was higher than DT subjects (median 8 vs 7, respectively, p?=?0.01). VR subjects’ impression of their understanding of the subject matter was higher than desktop subjects (median 7 vs 5, respectively, p?=?0.01). There was no statistically significant difference in the knowledge acquisition observed between the stereoscopic virtual reality group and the monoscopic desktop-based group. Participants in virtual reality reported a better learning experience and self-assessment suggesting virtual reality may increase learner engagement in understanding congenital heart disease.

     

Three-dimensional echocardiographic virtual endoscopy for the diagnosis of congenital heart disease in children

Virtual endoscopy (VE) is a new post-processing method that uses volumetric data sets to simulate the tracks of a “conventional” flexible endoscope. However, almost all studies of this method have involved virtual visualizations of the cardiovascular structures applied to computed tomography (CT) and magnetic resonance (MR) datasets. This paper introduces a novel visualization method called the “three-dimensional echocardiographic intracardiac endoscopic simulation system (3DE IESS)”, which uses 3D echocardiographic images in a virtual reality (VR) environment to diagnose congenital heart disease. The aim of this study was to analyze the feasibility of VE in the evaluation of congenital heart disease in children and its accuracy compared with 2DE. Three experienced pediatric cardiologists blinded to the patients’ diagnoses separately reviewed 40 two-dimensional echocardiographic (2DE) datasets and 40 corresponding VE datasets and judged whether abnormal intracardiac anatomy was present in terms of a five-point scale (1 = definitely absent; 2 = probably absent; 3 = cannot be determined; 4 = probably present; and 5 = definitely present). Compared with clinical diagnosis, the diagnostic accuracy of VE was 98.7% for ASD, 92.4% for VSD, 92.6% for TOF, and 94% for DORV, respectively. Diagnostic accuracy of VE was significantly higher than that of 2DE for TOF and DORV except for ASD and VSD. The receiver operating characteristic (ROC) curve for VE was closer to the optimal performance point than was the ROC curve for 2DE. The area under the ROC curve was 0.96 for VE and 0.93 for 2DE. Kappa values (range, 0.73–0.79) for VE and 2DE indicated substantial agreement. 3D echocardiographic VE can enhance our understanding of intracardiac structures and facilitate the evaluation of congenital heart disease.     

多平面经胸动态三维超声心动图对先天性心脏病的研究

目的 探讨多平面经胸动态三维超声心动图对先天性心脏病的诊断价值。方法 对３２例先天性心脏病患者进行多平面经胸动态三维超声心动图检查,部分患者与手术结果对照。结果 ３２例患者中有３０例获得了满意的三维图像,其中１６例接受手术的患者,动态三维超声心动图的诊断与手术发现相符合。结论 多平面经胸动态三维超声心动图为先天性心脏病的定性及定量诊断提供了可靠的新方法。     

Three-Dimensional Echocardiography in Adult Congenital Heart Disease

Advances in transducer technology have made three-dimensional echocardiography feasible for routine use in the echocardiographic assessment of cardiovascular disease. Real-time three-dimensional echocardiography (RT3DE) has potential to be especially useful in the evaluation of patients with congenital heart disease, by providing a detailed assessment of complex morphologic abnormalities and the spatial relationships of intracardiac structures. In patients with congenital heart disease, the ability to accurately assess cardiac chamber volumes and ejection fraction is important for determining the timing of intervention. In this article, we review the published literature on the use of 3DE in the assessment of morphology, chamber volume, and function in patients with congenital heart disease, as well as the use of RT3DE to guide interventional procedures.     

上下心的超声心动图表现及诊断

目的 观察上下心的超声心动图特征及诊断方法,并探讨上下心与十字交叉心的关系.方法 回顾性分析14例确诊上下心患者的二维超声心动图和彩色血流多普勒特征,探讨其诊断要点及诊断方法.结果 14例患者右心室及左心室均呈上下排列,其中9例为十字交叉心,5例为三尖瓣闭锁伴右心室发育不良及心室大动脉连接异常;12例为心房正位,13例房室连接关系一致,7例伴有完全性大动脉转位,7例伴有右室双出口,14例全部伴有室间隔缺损.结论 超声心动图能够清晰显示室间隔定位,对上下心进行明确诊断;上下心不等同于十字交叉心,也可存在于其他复杂先天性心脏畸形之中.     

超声心动图Z值在儿童心脏疾病诊疗中的应用进展

儿童先天性心脏病、后天获得性心脏病、心肌病中,对儿童心脏结构、大小和功能的评价是决定治疗方案和判断预后的重要因素。传统的超声心动图常以个体的心脏测量绝对值来评估心脏的结构和功能变化,对处于生长变化的儿童,则易造成判断偏倚。Z值将超声心动图测量结果经体表面积标准化转换,从统计学方法上寻求解决办法。本文就超声心动图Z值在儿童心脏疾病诊疗中的应用进展进行综述。