瓣环扩大在儿童主动脉瓣膜置换术中的应用

目的总结6例儿童主动脉瓣膜置换术中主动脉瓣环扩大的经验，探讨儿童主动脉瓣置换时主动脉瓣环细小的外科处理方法。方法主动脉瓣膜置换术中进行瓣环扩大术6例，年龄7～14岁，平均（11．2±3．3）岁；体重20～41．5kg，平均（29．5±8．6）kg，体表面积0．8～1．35m^2，平均（1．08±0．23）m^2。术前测定主动脉瓣环直径13．5～18．7mm，平均（15．9±2.6）mm。术中主动脉瓣环扩大2例采用Manouguian法，4例采用Konno法。经瓣环扩大后，主动脉瓣环植入了平均直径（19．2±1．3）mm（17～21mm）的机械瓣膜。其他心脏畸形也在术中予以矫治。结果无住院死亡。随访时间3～89个月，无晚期死亡，无再次手术。NYHA心功能分级均为Ⅰ级。复查超声心动图2例存在跨瓣压差，分别为25mmHg和40mmHg。结论儿童主动脉瓣膜置换术中，采用主动脉瓣环扩大术，特别是Konno法，可有效扩大狭窄的主动脉瓣环，植入较大的人工瓣膜，提高手术的成功率，改善远期疗效。     

Ross手术的临床应用进展

在儿童期选择满意的人工瓣置换主动脉瓣比较困难，所有的人工瓣对儿童均有内在的缺点，猪生物瓣和异体主动脉瓣型号大小比较适合儿童，但在主动脉瓣的位置早期会出现钙化和退行性变，因此限制了在儿童的应用。自体肺动脉瓣置换主动脉瓣，再用同种异体带瓣管道重建右心室流出道，此即目前所称的Ross手术。由Donald Ross于1967年首先报道该手术治疗主动脉瓣病变，但由于手术复杂，最初的患儿病死率很高，因此，未能得到及时推广。     

儿童主动脉瓣病变的外科治疗策略

目的 探讨儿童主动脉瓣病变的外科治疗策略.方法 回顾性分析2010年1月至2016年1月间收治的13例主动脉瓣病变患儿的临床资料.其中,男9例,女4例;年龄1～12岁,年龄分布1～3岁6例,3～6岁3例,6～12岁4例;体重12～36 kg,平均24 kg.术前经心脏超声及心脏CT明确诊断,先天性主动脉瓣病变8例,后天获得性主动脉瓣病变5例.手术在全身麻醉、低温、体外循环下进行,结合超声、CT及术中情况决定手术方式.结果 全组13例中,行改良Ross手术4例,主动脉瓣成形术3例,主动脉瓣机械瓣置换手术3例,Bentall术1例,Ross手术2例.全组无手术死亡,术中采用冷血停跳液或冷晶体停跳液灌注,合并主动脉关闭不全时,切开直接灌注,术中均应用超滤.术后有效随访患儿11例,2例患儿未规律随访,随访时间6个月～5年,全部存活,正常生活不受影响.机械瓣置换的长期使用华法林抗凝,目前无并发症出现.2例随诊过程中发现瓣膜压差大于40 mmHg,一般状况可,随访中未发现明显瓣膜严重反流.结论 儿童主动脉瓣病变的外科治疗方法有多样性的特点,本文旨在为心外科医师在儿童主动脉瓣病变的治疗策略方面提供更多的临床经验,儿童主动脉瓣疾病治疗的临床效果还有待进一步探讨.     

自体心包修复儿童主动脉瓣狭窄9例病例系列报告

目的：总结并分析以自体心包修复儿童先天性主动脉瓣狭窄的手术方法和早期预后。方法：纳入2013年7月至2015年6月在复旦大学附属儿科医院行自体心包主动脉瓣成形术的先天性主动脉瓣狭窄患儿,收集患儿的一般资料,围手术期情况,并发症,术前、术中、术后和随访时的超声心动图资料。结果：符合本文纳入标准的9例患儿进入本文分析,男6例,女3例,年龄4月龄至9岁。术前超声提示,三叶式和二叶式主动脉瓣分别为3例和6例;重度狭窄6例,中度狭窄1例,重度狭窄伴中度返流2例。9例均以自体心包再造或扩大主动脉瓣瓣叶。术后即刻与术前超声心动图比较：主动脉瓣最大跨瓣压差［（31.6±9.4）mm Hg vs（73.0±22.2）mm Hg, P=0.000］和主动脉瓣平均跨瓣压差［（15.8±18.3）mmHg vs （35.8±18.3）mmHg, P= 0.004］均下降。术后随访24～48（32±8）月,无死亡和再干预病例,未见严重不良事件,未见主动脉瓣重度狭窄或重度反流、升主动脉狭窄或扩张、主动脉瓣瓣环狭窄与扩张、瓣膜脱垂或瓣膜赘生物病例;3例患儿分别在随访18、24和12个月时出现瓣叶活动僵硬,瓣叶开放不完全。术后左室后壁厚径均呈下降趋势;末次随访时,8例患儿左室后壁厚径Z值（Z-LVPWd）均下降至正常水平（＜2）。结论：以自体心包修复主动脉瓣可改善先天性主动脉瓣狭窄患儿的血流动力学,手术风险低,术后早期疗效可,避免或延缓儿童主动脉瓣置换术,减少施行ROSS手术机会。     

同种带瓣管道治疗复杂先天性心脏病(附31例报告)

目的研究同种带瓣管道治疗复杂先天性心脏病的疗效。方法1997年12月～2003年4月，我科应用同种带瓣管道治疗复杂先天性心脏病31例。病种包括重症法乐氏四联症(TOF)14例，其中合并动脉导管未闭(PDA)1例，合并肺动脉闭锁(PA)、右肺动脉缺如(RPaA)各1例，PDA PA 1例，右冠状动脉畸形(RCaA)2例；右室双出口(DORV)8例，其中合并RCaA2例；三尖瓣闭锁(TA)1例；大动脉转位(L-TGA)并室间隔缺损(VSD)、肺动脉狭窄(Ps)3例；永存动脉干(PTA)2例；主动脉缩窄(CoA)并PDA 1例；VSD并PS、RCaA 1例；亚急性细菌性心内膜炎(SBE)1例。术式：主、肺动脉单瓣作右室流出道跨瓣补片术14例；Rastelli手术11例；右心室-肺动脉连接(RV-PA)3例；肺动脉瓣置换1例：Ross手术1例；改良Fantan手术1例。结果主、肺动脉单瓣作右室流出道跨瓣补片组14例，1例术后3d死于右心功能不全(7．14％)。存活13例，随访3～57月，超声心动图检查显示移植后瓣膜启闭功能良好，无增厚及粘连。同种带瓣管道移植矫治组17例，死亡7例(41．2％)，存活10例，随访9～57月，管道血流通过顺畅，管壁无变薄、钙化。结论同种带瓣管道具有管壁弹性好，易于缝合，术后排斥反应少等优点，可广泛应用于复杂先天性心脏病矫治术、左，右室流出道的重建。同种带瓣管道补片既能加宽右室流出道，且有良好抗反流作用，有利于术后患儿心功能恢复，使部分复杂的病例能够一次手术根治。     

先天性巨结肠经肛门Soave Ⅰ期拖出术后功能随访

目的评估先天性巨结肠经肛门Soave Ⅰ期拖出术后排便功能。方法随访2000年10月-2004年10月经肛门Ⅰ期拖出术44例，开腹Soave术35例，腹腔镜Soave术29例，Ikeda-soper术39例。术后随访1～5年。对围手术期疗效（术前准备时间、手术时间、术中输血量、术后禁食天数、应用抗生素时间、住院天数及费用）及术后排便控制能力（Kelly评分和直肠肛管测压）进行评估。结果经肛门Ⅰ期拖出术平均手术时间（75±20）min、费用（8198．81元）低于开腹术[（92±25）min；10264．45元]、腹腔镜术[（125±25）min；12504．67元]（P〈0．05）；术前肠道准备（2d）、手术时间（75±20）min、术中输血量（0例）、术后禁食天数（2d）、应用抗生素时间（4±1）d、住院天数（11±2）d及费用（8198．81）元较Ikeda-soper术[（4±1）d；（240±30）min；32例；（5±1）d；（7±2）d；（19±3）d；15243．78元]显著降低（P〈0．01）。经肛门Ⅰ期拖出术后的近远期并发症发生情况与开腹术、腹腔镜术无显著差别（P〉0．05）；Soave术后3个月小肠结肠炎的发生率（12例）高于Ikeda-soper术（3例）（P〈0．05），但就经肛门Soave术（5例）与Ikeda-soper术（3例）比较，差异无显著性意义（P〉0．05）。经肛门Ⅰ期拖出术和Ikeda-soper术患儿术后12个月Kelly评分无差别；术后1年直肠肛管测压均未引出直肠肛管抑制反射，术后肛管高压区长度、肛管静息压、直肠感觉阈值无统计学差异，但经肛门SoaveⅠ期拖出术后主动收缩压（52．3±15．6）mmHg低于Ikeda-soper术后（55．7±15．4）ramHg。结论经肛门SoaveⅠ期拖出术创伤小、并发症少、费用明显低于开腹、腹腔镜Soave术以及Ikeda-soper术，适用于治疗小年龄婴幼儿的短段型和常见型先天性巨结肠。     

一岁以内法乐四联症外科根治手术

目的总结91例1岁以内进行法乐四联症（TOF）外科根治手术经验。方法2000年1月2005年12月，我单位对91例小于1岁的TOF患儿进行Ⅰ期根治手术，手术时平均年龄为（7．92±0．4）个月（17d～11．8个月）；平均体重为（6．98±0．3）kg（1．7～10．2kg）；男63例，占69．2％，女28例，占30．8％；无症状3例，占3．3％，有症状88例，占96．7％，其中，缺氧发作的有23例，占25．3％。术前均经过心脏彩超和心导管及造影或心脏螺旋CT检查确诊。手术均在中到深低温体外循环下进行，93．4％的患儿行跨瓣环补片（TAP）扩大右室流出道，经右室或右房切口修补室间隔缺损，同期完成其他合并畸形的矫治。平均M率（McGoon Index）为1．88。结果总住院病死率为7．7％，平均主动脉阻断时间为55．2min，体外循环时间为88．2min，肺动脉瓣反流轻度65例，占71．4％，无Ⅲ度房室传导阻滞，轻度右室流出道梗阻5例。结论早期进行TOF根治手术可以取得良好的手术效果和相对低的手术病死率。     

盆底肌悬吊术治疗女性尿道下裂合并排尿困难

目的探讨女性尿道下裂患儿合并排尿困难、尿失禁的原因，并寻找合适的治疗方法。方法总结11例排尿困难、尿失禁而同时合并有尿道下裂的女性病例，接受髂腰肌转移盆底肌悬吊术治疗。结果11例术后随访6～30个月，平均18个月，控尿满意（昼夜均能保持3h以上完全干燥）7例，好转（部分控尿，白天偶有尿失禁或夜间尿床）3例，无效（症状无改善）1例，总有效率为90．9％。术前最大膀胱容量（162．5±69．8）ml、漏点压（33．4±7．5）cmH2O（1cmH2O=0．098kPa）、最大尿道压（37．4±12．7）cmH2O、最大关闭压（23．8±12．2）cmH2O、功能尿道长度（2．4±1．6）cm；残余尿（93±56）ml；术后分别为（201．6±62．3）ml、（49．8±15．4）cmH2O、（52．8±14．3）cmH2O、（32．8±11．6）cmH2O、（3．6±2．0）cm，（25±20）ml，均较术前明显改善（P〈0．01）。泌尿系感染频率和程度较治疗前明显减少和减轻。结论髂腰肌转移盆底肌悬吊术可以作为女性尿道下裂合并尿失禁、排尿困难的可供选择的治疗方法。     

完全性大动脉错位动脉转位术后新主肺动脉发育的随访

目的 报道应用动脉转位术（ASO）治疗完全性大动脉错位（TGA）术后超声心动图的随访结果,评价TGA术后主、肺动脉的发育情况。方法 以2001年3月至2007年3月于复旦大学附属儿科医院心血管中心实施ASO治疗TGA术后存活患儿作为研究对象,于2008年8～9月进行随访,行超声心动图检查,测定新主动脉根部内径、新主动脉瓣环内径、新肺动脉内径和新肺动脉瓣环内径,获取的数据与正常参考值做比较。 结果 研究期间ASO治疗TGA患儿共72例,术中死亡6/72例（8.3％）,存活率为91.7%。失访10/66例,有效数据56例,其中室间隔完整的完全性TGA（TGA/IVS）32例,完全性TGA合并室间隔缺损（TGA/VSD）24例。随访距手术18～168(86.46±23.51)个月。新主动脉根部内径为(16.97±2.71) mm(t=6.936,P<0.001),12/56例(21.4%)>正常参考值90%CI的上限, 44/56例(78.6%)在正常参考值90%CI内,平均Z值为1.10±0.70。新主动脉瓣环内径为(16.27±2.38) mm(t=4.52,P<0.001),56例均在正常参考值90%CI内,平均Z值为0.66±0.65。新肺动脉内径为(14.29±1.92) mm(t=-3.2,P=0.005), 40/56例(71.4%)在正常参考值90%CI内,16/56例(28.6%)<正常参考值90%CI的下限,平均Z值为-0.95±1.33。 新肺动脉瓣环内径为(14.00±1.92) mm(t=0.132,P=0.897), 42/56例(75.0%)在正常参考值90%CI内,14/56例(25.0%)<正常参考值90%CI的下限,平均Z值为0.05±1.85。16/56例(28.6%)存有主动脉瓣轻度反流,均为TGA/VSD病例,平均随访(46.0±22.2)个月;40/56例（71.4％）未见主动脉瓣反流,平均随访(46.8±25.3)个月,两组随访时间差异无统计学意义（P=0.899）。随访中未见主动脉狭窄病例。肺动脉瓣上狭窄7/56例(12.5%),2/56例(3.6%)为轻度狭窄,5/56例(8.9%)为极轻度狭窄。结论 目前在复旦大学附属儿科医院心血管中心开展ASO治疗TGA术后新主动脉根部和瓣环内径均有所扩张,新肺动脉根部内径有所缩减,但其瓣环发育良好。主动脉瓣反流常见于TGA/VSD病例,但其反流程度较轻。肺动脉瓣上狭窄是TGA术后常见的并发症,但大多数病例狭窄程度极轻。     

应用自体心包塑型三瓣叶肺动脉瓣的研究

目的总结8例自体心包塑型三瓣叶肺动脉瓣在婴幼儿右室流出道重建术中的应用。方法以白体心包构建三瓣叶肺动脉瓣行右室流出道重建术,并行随访观察。结果本研究8例患儿无围术期死亡病例。平均ICU治疗时间（46±12．5）h,平均呼吸机辅助通气时间（22±6．7）h,术后存在少量瓣膜返流3例,出ICU时SaO2为0．96±0．02。经（22±7．6）个月随访,均无管道钙化征象;2例轻度瓣膜返流,1例中度返流合并瓣膜水平之上狭窄。2年管道无功能障碍率为87．5％。结论自体心包塑型三瓣叶肺动脉瓣在婴幼儿,尤其是管道直径〈15mm的右室流出道重建术中具有良好的中期效果。     

大动脉转换术后瓣膜反流的危险因素分析

目的 随访分析大动脉转换术(arterial switch operation, ASO)后的主动脉瓣反流和肺动脉瓣反流情况,以进一步评价ASO中长期疗效. 方法 1999年12月至2007年12月采用大动脉转换术纠治完全性大动脉错位(TGA)和右心室双出口伴肺动脉瓣下室间隔缺损(Taussig-Bing)术后生存288例,随访到228例,随访时间(20.4±18.6)个月.根据ASO术后彩色多普勒超声报告所测主、肺动脉瓣闭合情况,分析瓣膜反流的危险因素.结果 室间隔完整型大动脉错位(TGA/IVS),大动脉错位伴室间隔缺损(TGA/VSD),Taussig-Bing和Ⅱ期大动脉转换术(Stage-Switch),四组间的主动脉瓣反流发生率差异有统计学意义(P=0.010),而肺动脉瓣的反流率差异无统计学意义(P＞0.05).多因素分析提示主动脉瓣反流(AR)危险因素是手术时年龄(＞60d),AO/PA值(＞1.10),出院时主动脉瓣有反流.单因素分析提示肺动脉瓣反流(PR)危险因素与出院时肺动脉瓣是否存在反流有关.结论 主动脉瓣随着随访时间延长反流发生率增加.ASO术毕时主动脉瓣或肺动脉瓣的轻度反流,随访中可以消失或者减轻.ASO术后须定期随访,不但要注意吻合口的生长,还要观察主动脉瓣和肺动脉瓣的功能.     

Imperforate tricuspid valve with dysplasia of the right ventricular myocardium,pulmonary valve,and coronary artery: A clinicopathological study of nine cases

Summary Nine cases of imperforate tricuspid valve associated with dysplasia of the right ventricular myocardium, pulmonary valve, and right coronary artery are described. The mean frontal QRS axis of the electrocardiograms did not indicate left axis deviation in seven of the nine. Two-dimensional echocardiograms showed an imperforate tricuspid valve, normally aligned atrioventricular septum, and an irregular-shaped right ventricular cavity with a thin wall. In three cases with absence of the pulmonary valve, pulsed Doppler echocardiograms of the right ventricular outflow tract revealed antegrade flow during systole and retrograde flow during diastole, and selective angiography through a persistent ductus arteriosus showed retrograde filling of the blind-ended right ventricular cavity via the main pulmonary artery. Necropsy examinations showed an imperforate tricuspid valve with a thin-walled aneurysmal right ventricle in all six cases examined. Pulmonary atresia was observed in two cases, and the absence of the pulmonary valve in four. The right coronary artery was hypoplastic in four cases and absent in two. A shunt operation should be carried out in early infancy to prevent hypoxia after closure of the ductus arteriosus.     

“Absent” pulmonary valve with atrial septal defect and patent ductus arteriosus

Summary The case of a newborn with absent pulmonary valve, atrial septal defect, and patent ductus arteriosus is reported. He underwent surgical repair at five weeks of age, with closure of the patent ductus arteriosus and porcine pulmonary valve insertion. The clinical course leads us to suggest that reduction of pulmonary artery pressure and pulmonary valve competence will lead to prompt improvement in tracheobronchial compression and respiratory symptoms; no pulmonary arterioplasty is needed.     

儿童心脏瓣膜置换术

目的儿童心脏瓣膜疾病的外科处理，原则上应尽可能的采用修复技术进行治疗，但对瓣膜病变严重的患儿，则需行瓣膜置换术。本文旨在探讨儿童心脏瓣膜置换术的手术适应证，人工瓣膜的选择以及瓣膜置换术后长期抗凝等问题。方法总结43例16岁以下儿童瓣膜替换术的经验。结果全组长期存活41例，死亡2例，存活的41例中，除1例患儿发生右心室室壁瘤外，其余患儿心功能均恢复良好，无一例因生长发育出现心脏人工瓣膜相对狭窄及因抗凝引起的出血或血栓并发症。结论儿童人工心脏瓣膜置换术在慎重掌握手术适应证的基础上，有较好的临床效果。儿童心脏瓣膜置换应选择人工机械瓣膜。儿童瓣膜置换术后的抗凝需要经常定期地监测各项抗凝指标并随时做出适当的调整。     

Aplasia of semilunar valve leaflets: Two case reports and developmental aspects

Summary Two fetuses of approximately 11 weeks development with aplasia of the pulmonary as well as the aortic valve leaflets are reported. Both cases showed additional cardiac malformations. Case 1, with all leaflets missing, also had double-outlet right ventricle, hypplastic left ventricle, large ventricular septal defect, straddling tricuspid valve, and atretic mitral valve. Case 2, with only one hypoplastic aortic valve leaflet, showed hypoplasia of the mitral valve and the left ventricle, and a subaortic ventricular septal defect.The observations made and data in the literature suggest that aplasia of semilunar valve leaflets reflects an underdevelopment of the endocardial cushion swellings at the ventriculoarterial junction, rather than resulting primarily from a malseptation of the cardiac outflow tract.     

儿童心脏瓣膜置换术早期及中长期效果分析

目的评价儿童瓣膜置换术围术期及中长期疗效，探讨儿童瓣膜置换术适应证，分析术后抗凝特点及避免或减缓再次手术的方法。方法回顾性分析1991年12月至2006年8月，113例患儿128枚瓣膜置换术围术期疗效及中长期随访结果。结果住院死亡5例（4．4％），其中3例死于低心排综合征，1例死于心律失常，1例死于多器官衰竭。晚期死亡7例（6．5％），其中3例死于抗凝相关并发症。23例生物瓣膜置换患儿中有4例患儿需要行再次手术换瓣，随访的75例机械瓣置换患儿中有8例出现抗凝相关并发症。结论在严格掌握手术适应证的基础上，儿童人工心脏瓣膜置换术有较好的早期及中长期效果，但应尽量置人较大型号的瓣膜并选用相应的手术技巧，以保障儿童的成长，以避免或延缓再次手术，抗凝并发症是儿童瓣膜置换术后应该重视的问题。     

Ebstein's malformation of the mitral valve in atrioventricular and ventriculoarterial concordance

Summary Clinical and pathological data of a full-term male newborn with Ebstein's malformation of the mitral valve are reported. Moderate cyanosis and progressive heart failure were present from birth and he died on the fourth day after birth, with clinical evidence of severe aortic coarctation. Necropsy revealed a severely dysplastic mitral valve, with anatomical features of Ebstein's anomaly, in the absence of corrected transposition but associated with aortic coarctation.     

Diagnosis and Assessment of Valve Stenosis and Regurgitation and Coarctation of the Aorta with Doppler Ultrasound

ABSTRACT. With the use of Doppler ultrasound localized increases in blood flow velocities can be recorded and used to diagnose obstructions to blood flow. From the increase in maximal velocities the pressure drop across an obstruction can be calculated, both the peak instantaneous and the mean pressure drop. Regurgitations are diagnosed by recording reversal of blood flow across the valve. Semi-quantitative evaluation of the degree of regurgitation can be made by using both jet width, extension and intensity, as well as increase in forward flow velocity, reversal of flow in great vessels and influence on pressures. In coarctation of the aorta localized increase in velocity in the descending aorta can be shown and the pressure drop can be calculated. In some, more than one level of obstruction can be shown. In neonates the presence of a patent ductus arteriosus may mask the obstruction and a significant pressure drop may become apparent only when narrowing or closure of the duct occurs.     

Isolated congenital mitral valve regurgitation presenting in the first year of life

Aim: Isolated congenital mitral regurgitation is rare and, when presenting in infancy, reflects severity of the malformation. The natural history is often fatal, and management during the first year of life remains a therapeutic challenge. These infants are poorly understood largely because of an absence of reporting in the medical literature and limited experience in each institution. We reviewed our own experience in order to add to the understanding of this condition. Methods: A retrospective review was performed on seven infants with significant isolated congenital mitral regurgitation. An associated patent ductus arteriosus was present in two. Mean age at referral was 17.7 weeks (1 day to 47 weeks) and mean weight was 6.8 kg (3.7–12.5 kg). Results: Two infants were managed conservatively, and one underwent surgical ligation of a patent ductus arteriosus. Following spontaneous and surgical duct closure, no further intervention was required in two infants. The remaining four infants underwent three valve repairs and three valve replacements. The in‐hospital mortality was 29%, occurring in those under 1 year of age undergoing emergency valve surgery. Two reoperations followed mitral valve repair in the first year of life. No significant complications or late deaths occurred. Conclusions: Our experience suggests closure of a patent ductus arteriosus should be undertaken prior to mitral valve surgery. There may be a poorer prognosis in those under one year of age requiring emergency mitral valve surgery. Those who can be managed conservatively or undergo mitral valve surgery as an elective procedure tend to have a better outcome.     

Normal Mitral and Aortic Valve Areas Assessed by Three- and Two-Dimensional Echocardiography in 168 Children and Young Adults

Our purpose was to investigate the effects of body size on the sizes of mitral (MV) and aortic valve (AV) areas by three-dimensional (3-D) and two-dimensional (2-D) echocardiography and to create the normal values for 3-D echocardiography. A total of 168 healthy subjects aged 2–27 years were studied by digitized 3-DE, 2-DE, and Doppler echocardiography. 3-D echocardiography was performed by using rotational acquisition of planes at 18° intervals from a parasternal view with electrocardiogram gating and without respiratory gating. The annular levels of MV and AV were identified from short-axis cut planes and their areas were measured by planimetry. The diameters of mitral annulus, left ventricular outflow tract (LVOT), and aortic annulus were measured by 2-DE from the apical and parasternal long-axis views. Flow indices were measured by Doppler from MV inflow and the flow in LVOT and in the ascending aorta. Both MV and AV annular areas increased linearly in relation to body size. In the total study group the estimated areas for MV were 5.2 ± 0.9 cm²/m²by 3-DE, 3.7 ± 0.5 cm²/m² by 2-DE, and 2.0 ± 0.4 cm²/m² by continuity equation. The respective values for AV were 2.7 ± 0.5, 2.1 ± 0.3, and 1.8 ± 0.4 cm²/m². MV velocity time integral (VTI)/ascending aorta VTI increased from 0.80 (0.26) to 0.95 (0.23) with increased body surface area (BSA), whereas MV VTI / LVOT VTI was 1.2 (0.2) in all BSA groups. MV and AV annulus areas increase linearly in relation to body size. 3-DE gives greater estimates for the areas than 2-DE and Doppler equation methods. The data obtained from 168 healthy subjects may serve as a reference for clinical use in patients with various cardiac abnormalities.