二维及三维超声心动图诊断左房室瓣脱垂在外科手术中的应用

目的通过二维及三维超声心动图诊断左房室瓣脱垂的部位及病理分型,选择合适的外科手术。方法 30例左房室瓣脱垂患者,于左房室瓣外科手术前行二维及三维经胸超声心动图检查,分析左房室瓣瓣膜病变特点,并与外科手术结果对照。结果二维及三维经胸超声心动图定性诊断左房室瓣脱垂的准确率为100%,诊断左房室瓣脱垂病理类型准确率为93.31%（28/30）,定位诊断左房室瓣前、后叶病变区域的准确率为90.0%（27/30）。结论二维及三维经胸超声心动图能清晰显示左房室瓣脱垂的病因及具体部位,选择合适的外科手术。     

主动脉左室通道术后随访研究

目的:评价主动脉左室通道外科治疗结果,探讨超声心动图在主动脉左室通道的外科治疗后随访中的临床应用价值.方法:随访我院1999-03至2008-08手术治疗的主动脉左室通道8例患者,均行常规二维超声心动图检查,5例患者同时行三维超声心动图检查.结果:二维超声心动图检杳显示未行主动脉瓣替换者主动脉瓣无反流1例,轻度主动脉瓣反流1例,轻～中度主动脉瓣反流2例,主动脉左室通道再通1例;行主动脉瓣替换者机械瓣功能正常2例,瓣周漏1例.三维超声心动图以多种视角观察主动脉瓣及临近组织,进一步补充诊断.结论:主动脉左室通道外科治疗后应长期随访观察,超声心动图在随访中发挥重要的作用,实时三维超声心动图在二维超声心动图基础上,能显示主动脉瓣及其临近结构的空间立体结构,进一步协助诊断.     

经食管二维和三维超声心动图对二尖瓣人工机械瓣瓣周漏定位诊断价值

目的:探讨经食管实时二维和三维超声心动图诊断二尖瓣瓣人工机械瓣瓣周漏的临床价值。方法:回顾分析二尖瓣人工机械瓣瓣周漏26例的二维、三维经食管超声心动图表现特征,并与术中所见进行对比。结果:26例二尖瓣人工机械瓣瓣周漏患者,术中发现二尖瓣人工机械瓣瓣周漏36处,其中6例同时存在2处漏口,2例同时存在3处漏口。经食管实时三维超声心动图共发现瓣周漏30处,与术中发现符合率100%,二维经食管超声心动图共发现瓣周漏28处,与术中发现符合率77.8%。结论:经食管实时三维超声心动图能够清晰显示二尖瓣人工机械瓣瓣周漏的位置、形态和大小,有利于术前手术计划的选择和制定。     

经胸实时三维超声心动图对房室间隔缺损的诊断价值

目的探讨经胸实时三维超声心动图对房室间隔缺损的诊断价值。方法回顾性分析2009年6月至2011年11月间首次二维超声心动图检查诊断为房室间隔缺损的81例患者,再做经胸实时三维超声心动图补充检查。81例房室间隔缺损均经手术证实。结果经胸实时三维超声心动图较二维超声心动图能提供更丰富的病变信息。结论经胸实时三维超声心动图能对房室间隔缺损诊断作更好的补充,对房室间隔缺损的术前评估及术后随访有重要的临床意义。     

重度主动脉瓣狭窄患者瓣环径二维及三维测量方法的比较

目的 比较不同的二维及三维方法对重度主动脉瓣狭窄患者瓣环径测值的差别,探讨最优测量手段.方法 32例重度主动脉瓣狭窄患者,分别行二维经胸超声心动图（TTE）、二维经食管超声心动图（TEE）及多排螺旋CT（MSCT）三维成像测量主动脉瓣环径.结果 MSCT显示主动脉瓣环为椭圆形结构,其长轴径（26.9±2.9）mm,短轴径（21.3±1.8）mm,长轴径与短轴径差异有统计学意义（P＜0.01）.TTE及TEE方法仅提供一个瓣环值,分别为（23.2±2.0）mm及（23.4±2.0）mm,均显著小于MSCT所测长轴径和短轴径的平均值（24.1±2.1）mm（P＜0.05）.结论 主动脉瓣环为椭圆形,瓣环径的测量采用三维MSCT方法更佳.     

实时三维超声心动图在经导管主动脉瓣置换术中的应用价值

目的:回顾性探究实时三维超声心动图在经导管主动脉瓣置换术(TAVR)的术前评估筛选、术中监测指导以及术后功能恢复评价中的意义和价值。方法:选取经超声心动图诊断的主动脉瓣中-重度狭窄并行TAVR的患者共54例,分析所有患者的术前疾病状态包括主动脉瓣形态、瓣口面积等参数,统计此类患者在术中所出现的瓣周漏的比例以及类型,比较术前、术后患者左心室功能数据改变,明确实时三维超声心动图在这类患者不同阶段所发挥的作用。结果:54例患者中以三叶式主动脉瓣居多,其中利用二维超声心动图联合实时三维超声心动图检出二瓣化畸形患者8例,1例疑似二瓣化畸形并最终由CT确诊;术中共发生36例少-中量瓣周漏,最终均由三维超声心动图明确瓣周漏位置及大小;利用三维超声心动图检测术前及术后患者左心室部分功能参数,与术前相比,患者术后主动脉瓣有效瓣口面积扩大、左心室射血分数提高、左心室收缩末期容积减小,差异均有统计学意义(P0.05)。结论:实时三维超声心动图在TAVR中能够协助临床医师进行术前疾病判断、术中实时监测和指导并精准评价手术的效果,为此类手术的临床推广带来帮助。     

二叶主动脉瓣的超声分析

目的 探讨二叶主动脉瓣的超声心动图特征。方法 采用回顾性方法分析了26例先天性二叶主动脉瓣,其中主动脉瓣狭窄17例（有或无主动脉瓣关闭不全）和单纯主动脉瓣关闭不全9例。结果 在主动脉瓣狭窄组、轻度狭窄14例（82％）;二叶主动脉瓣感染性心内膜炎的发生率为42％;主动脉瓣狭窄组与单纯主动脉瓣反流组相比,主动脉瓣增厚钙化有极显性差异（P＜0．00005）,结果表明,二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。结论：二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。二叶主动脉瓣感染性心内膜炎的发生率较高。彩色多普勒二维超声心动图对二叶主动脉瓣的诊断具有重要价值。     

实时三维超声心动图对主动脉瓣二叶畸形的再探讨

【】 目的：探讨实时三维超声心动图( RT-3DE)诊断主动脉瓣二叶畸形(bicuspid aortic valve malformation,BAV)的应用价值。方法：采用Philips iE Elite彩色多普勒超声诊断仪, S5-1和X3-1探头,检测36例BAV患者,经胸二维超声心动图( 2DE) 和RT-3DE通过胸骨旁左心室长轴切面及大动脉短轴切面, 观察主动脉瓣瓣膜数目、形态、启闭情况及血流动力学改变。结果：2DE确诊BAV28例,漏诊2例,不能明确6例,上述均经 RT-3DE复查并被临床证实,其中横裂式20例、纵裂式11例、斜裂式5例。钙化28例,占78%;瓣膜狭窄22例,占61%,轻度狭窄18例,中度狭窄4例,无重度狭窄;瓣膜关闭不全14例,占39%,轻度关闭不全11例,轻-中度关闭不全3例,无重度关闭不全。结论：RT-3DE对诊断BAV有重要价值,明显提高诊断符合率。     

实时三维超声心动图在经导管主动脉瓣植入术中对主动脉瓣环检测意义的研究

目的：分析实时三维超声心动图（real-time three-dimensional echocardiography,RT3DE）在经导管主动脉瓣植入术（transcatheter aortic valve implantation,TAVI）围术期的应用价值。方法：选择本院2018年10月至2021年10月，住院的100例TAVI手术患者作为研究对象，年龄在65～80岁，平均（72.9±5.0）岁。根据患者主动脉瓣的瓣膜形态、功能进行分组研究，分为先天性主动脉瓣发育异常组（n=45）与后天获得性主动脉瓣病变组（n=55），主动脉瓣关闭不全组（n=41）与主动脉瓣狭窄组（n=59），主动脉瓣狭窄合并主动脉瓣钙化组（n=44）与不合并主动脉瓣钙化组（n=56）。统计主动脉瓣前向血流平均压差、左心室腔大小及LVEF值；主动脉瓣环三维视图周长C3D、主动脉瓣环投影平面中二维视图周长及面积（C2D及A2D）、主动脉瓣环二维周长与三维周长之比（C2D/C3D）等数据进行统计学分析，然后采用Peason相关性分析主动脉瓣环参数与术中测瓣器测值的相关性。结果：100例患者均成功完成TAVI手术治疗...     

三维经食管超声心动图对室壁瘤患者左心室容积与功能的评价

目的:探讨应用三维经食管超声心动图(3D-TEE)定量评价左心室室壁瘤形成后左心室的形态、结构与功能。方法:35例心肌梗死后合并左心室室壁瘤形成的患者,于术前3 d之内进行经胸三维超声心动图和三维经食管超声心动图检查。对所获得的左心室舒张末期容积、收缩末期容积、左心室射血分数、收缩期二尖瓣口反流面积和室壁瘤容积等数据进行处理,对照分析2种方法所测得的结果。结果:32例患者可以获得优质图像,三维经食管超声心动图所测得左心室舒张末期容积、收缩末期容积、室壁瘤容积较三维经胸超声心动图所测得的数据偏高,而三维经食管超声心动图所测得的左心室射血分数偏低,二者差异有统计学意义(P<0.05)。结论:应用3D-TEE对心室重构、心腔扩大或室壁瘤形成的左心室评价更为精确。3D-TEE可以作为定量评价心肌梗死后室壁瘤形成患者的左心室容积、功能和室壁瘤大小的有效手段。     

Balloon atrioseptostomy in 2-dimensional echocardiography

Two-dimensional echocardiography allows complete evaluation of transposition of the great arteries including additional malformations. Pressure recordings and oxymetry are without indicative value in sick and hypoxic neonates and cardiac catheterization is therefore merely therapeutic (balloon atrial septostomy). In addition balloon atrial septostomy can be performed under echocardiographic control only. This procedure saves time and costs, avoids the risks of X-ray exposure and angiocardiography and can safely be performed in the pediatric intensive care unit. Five newborn babies with transposition of the great arteries were treated with this method.     

Applications of color-coded Doppler 2-dimensional echocardiography

Conventional Doppler techniques have been used for sometime, but are limited by personal skill and experience, as well as by the fact that it can sample only one specific cardiac site at a time. The introduction of color-coded Doppler flow imaging systems allows by using multiple sample volumes an immediate display of intracardiac blood flow, spatially-oriented and super-imposed in two-dimensional echocardiography images, that not only increase temporal resolution, but which integrates anatomic and functional analysis. Likewise, the objective visualization of abnormal jet lesions permits the application of continuous-wave Doppler echocardiography with a high veracity for derived pressure gradients. Color-coded Doppler echocardiography emerges as the most promising, simple and non-invasive technique for obtaining confident quantitative information in diverse cardiac pathologic conditions and research.     

Real-time 3-dimensional echocardiography evaluation of intracardiac masses

The size of an intracardiac mass (vegetation, tumor, or thrombus) is an important predictor for embolic events and for response to treatment. Maximum diameter measurements from two-dimensional (2D) echocardiography are routinely used to determine mass size. However, most masses are irregularly shaped, making it difficult to accurately image or select the largest diameter. The selection of a diameter that is not truly the largest may lead to underestimation of the true size of the mass and a misrepresentation of the patients' prognosis. Three-dimensional (3D) echocardiography images the entire volume of a mass allowing for accurate measurements in multiple planes. We tested the hypothesis that measurements of the maximum diameter of a mass by 3D echocardiography are larger than those obtained by 2D echocardiography. METHODS: Patients with findings of an intracardiac mass by 2D transthoracic (TTE) or transesophageal (TEE) echocardiogram were imaged using real-time three-dimensional echocardiography (RT3DE) within 24 hours. The complete mass was acquired on RT3DE. Maximum mass diameter was measured on 2D and RT3DE. Comparison of measurements between RT3DE and 2D was performed using correlation coefficients and Bland-Altman analyses. RESULTS: In 19 masses evaluated in 17 patients, there was a strong correlation between 2D TTE and RT3DE maximum diameter measurements (R2 = 0.88, P < 0.01) but correlation was fair for 2D TEE (R2 = 0.48, P = 0.02). In addition, 2D maximum diameter also correlated with 3D volumes (R2 = 0.72, P < 0.01 for TTE and R2 = 0.56, P < 0.01 for TEE). However, there was a consistent underestimation of maximum diameter measured by 2D (TTE and TEE) regardless of the size, location, and etiology of the mass. 2D TTE underestimates cardiac mass size by 24.6% (P < 0.001) compared to RT3DE and 2D TEE underestimated size by 19.8% (P = 0.01). CONCLUSION: These findings suggest that RT3DE may be the technique of choice for the noninvasive evaluation of intracardiac mass size.     

Assessment of quantitative methods for 2-dimensional echocardiography

Several 2-dimensional echocardiographic (2-DE) methods were tested in vitro for accuracy of linear and cross-sectional measurements and in vivo for left ventricular (LV) volume reconstruction. With 2-DE instrument settings at low and high gains and with precise in vitro calibrations, we studied myocardial slice thickness (3.0 to 10.0 mm). The 2-DE myocardial thickness was measured by leadingtrailing, trailing-leading, and leading-leading methods. Regression analysis of 2-DE versus direct measurements yielded excellent correlations for all 3 methods (r > 0.985), with interobserver variability < 3%. Accuracy of measurement was satisfactory only for the leading-leading method (3 and 6% error at low and high gains, respectively); other methods substantially over- or underestimated thickness. Thin myocardial slices (< 1 mm thick) were applied to cylinders and fixed in formalin to produce precise cavity areas (1.8 to 7.0 cm²). Regression analysis of 2-DE versus actual cavity area gave high correlations (r > 0.970), and low interobserver variability (< 4%) for the inner edge and leading edge methods, but the leading edge method was the most accurate (1.3 to 2.5% error). In vivo LV volumes in 7 anesthetized dogs were compared with 2-DE and cineangiography. Good correlations (r = 0.92) were obtained, but the inner edge method underestimated angiographic volume, whereas the leading edge method reduced the magnitude of underestimation. Thus, the leading edge method for 2-DE is most accurate not only for linear and cross-sectional measurements of the myocardium, but also for application to in vivo LV volumes.     

实时三维超声心动图技术及其临床应用

传统的二维超声心动图(2D)在心脏疾病的诊断中已被广泛应用。但由于它的二维特性使得它难于提供精确的定量信息,显示了其局限性,实时三维超声可为心血管疾病的准确诊断及治疗提供更多的有用信息。     

Real-time 3-dimensional echocardiography. Technique and clinical applications

This article will provide an overview of real time 3-dimensional (3D) echocardiography (RT-3D) in evaluation of patients with heart disease. We will briefly describe the technique and our experience in its clinical applications in patients with coronary artery disease, left ventricular apical thrombi, mitral stenosis and its role in guiding intracardiac catheter placement. Our extensive experience with application of RT-3D during dobutamine stress and during supine bicycle exercise indicates the technique is sensitive in detection of ischemia. RT-3D has been valuable in clearly identifying left ventricular apical thrombi in patients in whom 2-dimensional (2D) echo cannot firmly establish their presence or absence. We have utilized RT-3D in guiding myocardial biopsy in heart transplant patients and in precisely measuring mitral valve area before and after balloon valvuloplasty. RT-3D technique continues to evolve and should play an important role in assessment of patients with heart disease.     

Color-coded 2-dimensional Doppler echocardiography. Initial clinical experiences

A new technology based on the Doppler principle for ultrasound has recently enabled the real-time visualization of cardiac blood flow by superposition of coloured flow information onto a two-dimensional echocardiogram. This study presents typical flow patterns in standard echocardiographic views, obtained from normal subjects and patients with acquired valvular or congenital heart diseases. Diagnostic possibilities and limitations of colour-coded Doppler echocardiography are discussed.