实时三维超声心动图定量评价左心瓣膜病变伴随的功能性三尖瓣反流的可行性研究

目的:探讨实时三维超声心动图(RT-3DE)定量评价左心瓣膜病变伴随的功能性三尖瓣反流(FTR)的可行性.方法:100例拟行瓣膜置换术的左心瓣膜病变患者,于术前、术后1周、术后6-9个月行超声心动图检查,采集73例功能性三尖瓣反流的二维超声心动图(2DE)及RT-3DE图像,测量并计算瞬时三尖瓣最大反流容积、右心房容积、三尖瓣最大反流面积/右心房面积、三尖瓣最大反流容积/右心房容积.对相关指标进行配对t检验和直线相关分析.结果:三尖瓣最大反流容积、右心房容积及两者比值的2DE和RT-3DE测值差异有统计学意义(P＜0.05);但两种测值间具有较好的一致性和相关性,r=0.867,0.897.结论:RT-3DE定量功能性三尖瓣反流是可行的,用于临床评价功能性三尖瓣反流更为合理.     

实时三维超声心动图在急性心肌梗死并发症诊断中的临床应用

实时三维超声心动图（real—time three-dimensional echoear-diography，RT-3DE），也称四维超声心动图，能经胸快速实时地采集和同步三维显示心脏图像，并能切割显示任意切面观的心脏解剖结构，目前已应用于临床。本文收集2006年10月至2008年3月本院31例门诊或住院的急性心肌梗死合并有并发症的患者，对其RT-3DE检查进行分析、总结，旨在评价RT-3DE在急性心肌梗死并发症诊断中的临床价值。     

实时三维超声心动图和二维斑点追踪对冠心病患者左心室整体收缩功能与同步性的评价

目的 探讨实时三维超声心动图(RT-3DE)和二维斑点追踪显像 (2D-STI)评价心肌缺血和心肌梗死患者左室整体收缩功能和同步性的临床应用价值,及两种方法在评价左室收缩同步性方面的相关性。方法 46例心肌缺血患者（心肌缺血组）、44例心肌梗死患者（心肌梗死组）和60例健康志愿者（正常对照组）行RT-3DE和2D-STI检查,应用Qlab8.1软件脱机分析,获得左心室收缩功能参数:GLS、GCS、GRS、3D-LVEDV、3D-LVESV和3D-LVEF;同步性参数:Tls-l6-SD、Trs-l2-SD、Tcs-l2-SD、TAS-POST、Tmsv-l6-SD和Tmsv-16-Dif。 结果 与正常对照组比较,心肌缺血组常规超声心动图无阳性发现,2D-STI示GLS明显降低,Tls-16-SD明显延长（P<0.05）; RT-3DE“牛眼图”可见室壁运动异常的节段,Tmsv-16-SD、Tmsv-16-Dif明显延长（P<0.05）。心肌梗死组常规超声心动图、2D-STI 及RT-3DE均有阳性表现,RT-3DE与2D-STI同步性参数相关性分析示Tmsv-16-SD与TAS-POST呈正相关(r=0.574,P<0.01),其余参数无相关性。 结论 RT-3DE与2D-STI可早期客观评价心肌缺血组冠心病患者左室收缩同步性,且二者存在一定相关性。     

实时三维经食管超声心动图在二尖瓣脱垂合并感染性心内膜炎中的应用

目的 评价实时三维经食管超声心动图(RT-3D-TEE)在二尖瓣脱垂合并感染性心内膜炎(IE)中的应用价值。方法 选择二尖瓣脱垂合并IE患者20例,术前行经胸超声心动图(TTE)和RT-3D-TEE检查,分析脱垂部位及表现特征,并与术中所见进行对比。结果1RT-3D-TEE在二尖瓣脱垂的敏感性、特异性、阳性预测值、阴性预测值、总符合率方面整体均高于TTE。2RT-3D-TEE在诊断二尖瓣赘生物形成、腱索断裂、穿孔方面的敏感性、特异性整体均高于TTE。结论 1.RT-3D-TEE较TTE更能准确定位二尖瓣脱垂的部位2.RT-3D-TEE能准确显示IE的各种表现形式,对术前手术方式的选择有重要指导作用。     

胎儿三维超声心动图在胸腹联胎产前诊断中的体会

目的：探讨胎儿实时三维超声心动图（RT-3DE）在胸腹联胎产前诊断中的影像学特征。方法：选取我院2014.1-2015.1经产前超声筛拣出的对称性胸腹联胎5例,行胎儿二维超声心动图（2DE）及胎儿实时三维超声心动图检测。RT-3DE选择3D cropping、xPlane任意平面成像及3D-Beats模式,多切面多方位多角度观察胎儿心脏。结果：5例对称性胸腹联胎均有两个心包,两套心血管系统,其中一个心脏结构正常,另一个为单流入型单心室合并单心房或其他类型非紫绀型先天性心脏病。染色体检测多无异常。结论：对称性胸腹联胎胎儿超声心动图超声表现具有特征性,胎儿实时三维超声心动图是联体双胎产前超声诊断的良好补充。     

实时三维超声心动图对系统性红斑狼疮患者右心功能的评价

目的应用实时三维超声心动图（RT-3DE）评价系统性红斑狼疮（SLE）患者右心功能。方法将67例SLE患者与50例正常人分别用二维超声心动图与RT-3DE测量右室收缩末期容积（RVESV）、右室舒张末期容积（RVEDV）、右室射血分数（RVEF）。结果 67例SLE患者二维超声测值与对照组差异无统计学意义（P〉0.05）,SLE组的三维测量RVEDV、RVESV高于对照组,RVSV低于对照组（P〈0.01）,SLE合并肺动脉高压（PAH）组RV-EDV、RVESV均高于SLE不合并PAH组（P〈0.05）。结论 RT-3DE能够准确评价右心功能。     

实时三维超声心动图评价2型糖尿病患者左室功能及同步性的观察

目的 利用实时三维超声心动图（RT-3DE）评价T2DM患者左室收缩功能及同步性.方法 选取T2DM患者60例,根据BP水平分为T2DM合并高血压（T2DM＋-HT）组28例及单纯T2DM组32例,另设正常对照（NC）组30名,均行常规二维超声心动图及RT-3DE检查. 目的 T2DM＋ HT组及单纯T2DM组RT-3DE测量的左室射血分数（LVEF）均低于NC组（P均＜0.05）;与NC组相比,T2DM＋ HT组及单纯T2DM组左室容积-时间曲线各参数（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv1 6-Dif、Tmsv12-Di、Tmsv6-Di、Tmsv16-SD％、Tmsv12-SD％、Tmsv6-SD％、Tmsv1 6-Di f％、Tmsv12-Di f％、Tmsv6-Dif％）均较NC组增大（P均＜0.05）. 结论 应用RT-3DE技术可早期、准确评价T2DM患者左室收缩功能及其收缩不同步性.     

64排螺旋CT与实时三维超声心动图定量评价冠心病左室收缩功能的对比研究

目的比较64排螺旋CT（64-MDCT）和实时三维超声心动图（RT-3DE）定量评价冠心病患者左室收缩功能的临床应用价值。方法 108例冠心病患者同期行64-MDCT和经胸RT-3DE检查,测量左室舒张末期容积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）和左室射血分数（LVEF）,并采用逐步多元线性回归（SMLR）方法进行分析。结果 64-MDCT和RT-3DE测得左心功能各指标的数据在统计学上无统计学差异,采用SMLR法进行比较,r分别为EDV为0.835 2、ESV为0.804 3、SV为0.763 2、LVEF为0.897 1,P均〉0.05。两种方法所测EF值偏差较小,无统计学差异。结论 64-MDCT和RT-3DE两种方法在评价左室收缩功能方面具有很好的相关性,在准确测量左室收缩功能、有效评价冠心病左室重构和心脏功能损伤上可以互为补充。     

实时三维超声心动图对经导管闭合房间隔缺损术后的观察

目的 :探讨实时三维超声心动图 （RT- 3DE）对经导管闭合房间隔缺损 （ASD）术后观察的价值。方法 :对 15例ASD患者术后封堵器的位置、形态、塑型、大小及运动进行 RT- 3DE观察 ,并与手术结果进行比较。结果 :RT- 3DE显示封堵器呈双盘状 ,测得封堵器伞腰直径为 2 7± 5 mm ,与实际封堵器大小 （2 6± 5 mm ）比较无显著差异 （P>0 .0 5 ） ;封堵器相对房间隔无移位 ,随心脏运动 12例无扩展和收缩 ,形状也无变化 ,3例有变化。结论 :RT- 3DE成像速度快 ,模拟外科手术路径实时显示封堵器的位置、形态和塑形以及和周围组织的关系 ,可作为 ASD介入治疗术后疗效评价的重要手段。     

经食管实时三维超声心动图诊断先天性心脏瓣膜病的可行性及临床价值

目的:探讨经食管实时三维超声心动图诊断先天性心脏瓣膜病的可行性及临床价值。方法:选择本院收治的先天性心脏瓣膜病患者135例为研究对象,均接受手术治疗,术前7 d内先后进行经胸超声心动图(TTE)和经食管实时三维超声心动图(RT-3D TEE)检查,观察心脏瓣膜病变情况,并将二者的诊断结果与手术结果进行对比分析。结果:RT-3D TEE可多角度、立体、清晰地显示先天性心脏瓣膜病患者心脏瓣膜的形态结构、病变程度及周围血流情况,发现在TTE检查中难以明确的心脏瓣膜病变,并纠正其诊断偏差。以手术结果为"金标准",RT-3D TEE检查的诊断符合率显著高于TTE检查的诊断符合率(97.04%比91.11%,P=0.039)。RT-3D TEE与TTE诊断先天性心脏瓣膜病具有中等程度一致性(Kappa=0.477,P=0.001)。结论:经食管实时三维超声心动图能为先天性心脏瓣膜病的诊断提供更多的影像学信息,可作为术前经胸超声心动图检查的有效补充。     

实时三维超声心动图在房缺封堵术中的应用

目的探讨实时三维超声心动图(RT3DE)技术在经导管房间隔缺损(ASD)封堵术中的应用价值。方法57例连续先心病ASD行介入封堵治疗患者术前、术中及术后行经胸超声心动图(TTE)、经食管超声心动图(TEE)及RT3DE,测定ASD部位、大小、形态、以及与二尖瓣、三尖瓣的关系,术后封堵器的位置、形态、和残余漏。结果RT3DE显示ASD大多为不规则椭圆状。与TTE比较,RT3DE测得ASD最大径(P<0.05),ASD边缘与二尖瓣距离(P<0.01)及三尖瓣距离(P<0.05)差异有统计学意义。RT3DE在检测封堵后残余分流、封堵器对瓣膜活动影响及封堵器微脱位都优于TTE。结论RT3DE可准确测定ASD部位、大小、形态、以及与邻近解剖结构的关系,对封堵器选择、手术过程指导及术后疗效评价都非常有价值。     

Partial atrioventricular septal defect assessed by real-time three-dimensional echocardiography: a case report

A 48-year-old woman was admitted with a heart murmur and increased difficulty in breathing. Two-dimensional echocardiography revealed a defect in the lower part of the atrial septum [(primum atrial septal defect (ASD)] and a pouch at the interventricular septum. Color Doppler echocardiography detected grade 3/4 mitral regurgitation. Real-time three-dimensional echocardiography (RT-3DE) revealed a cleft in the anterior leaflet of the mitral valve toward the tricuspid valve, and the ASD located near the atrioventricular valves with 14mm in minor axis. Color Doppler three-dimensional echocardiography disclosed left-to-right ASD shunt toward the atrial posterior wall. No shunt through the pouch at the membranous part, left ventricular outflow obstruction, or partial anomalous pulmonary venous connection was observed. RT-3DE is quite useful to describe complicated congenital heart disease.     

Transthoracic real-time three-dimensional echocardiography in the diagnosis and description of noncompaction of ventricular myocardium

BACKGROUND: Numerous modalities have been used to diagnose and characterize noncompaction of ventricular myocardium (NCVM) including magnetic resonance imaging, two-dimensional echocardiography (2DE), contrast-enhanced 2DE, and angiography. The current case series examines the use of real-time three-dimensional transthoracic echocardiography (RT-3DE) in four such cases of NCVM. METHODS: From December 2003 to March 2004, we performed RT-3DE using a Philips Sonos 7500 echocardiographic scanner equipped with a 2-4 MHz 3D matrix array transthoracic probe, to evaluate four patients with NCVM. The real-time 3D transthoracic probe allows for dataset acquisition in an ultrasound wedge, which can be manipulated instantaneously. In addition, complete 3D volume rendering is acquired, allowing for volumetric imaging. RESULTS: The age range of the patients was 2 months to 42 years. One patient had the codiagnoses of coarctation of the aorta and bicuspid aortic valve. In all four patients, RT-3DE enabled diagnosis and provided detailed characterization of the affected myocardium. Entire trabecular projections and intertrabecular recesses were easily visualized simultaneously, and endocardial borders were clearly demarcated. Wall motion abnormalities of the affected myocardium were clearly visualized. The compacted and noncompacted portions of the myocardium could be differentiated well. CONCLUSIONS: Our study provides preliminary data highlighting the utility and feasibility of RT-3DE in the clinical characterization of NCVM. The complex 3D nature of this disorder and the endocardial hypertrabeculation were more readily visualized than with 2DE.     

实时三维经食管超声心动图定位二尖瓣脱垂部位临床应用

目的:分析二尖瓣脱垂的三维经食管超声心动图(RT-3D-TEE)表现,探讨其诊断二尖瓣脱垂的应用价值。方法:选取由于二尖瓣脱垂引起二尖瓣关闭不全,进行二尖瓣修复或置换的患者23例,术前及术后即刻均行RT-3D-TEE检查,分析二尖瓣脱垂的RT-3D-TEE表现特征及脱垂部位,并与术中所见进行对比。RT-3D-TEE成像切面均采用二尖瓣左心房面外科视野观。结果:23例患者术前即刻二尖瓣左心房面外科视野观均显示清楚,观察二尖瓣小叶共138个。术前RT-3D-TEE判断二尖瓣脱垂小叶33个,无脱垂小叶105个,其中腱索断裂17例;发现3例瓣叶赘生物。术中发现二尖瓣脱垂小叶35个,无脱垂小叶103个,其中腱索断裂16例;赘生物3例。RT-3D-TEE诊断二尖瓣脱垂的敏感性为91.4%,特异性为99%,阳性预测值为97.0%,阴性预测值为97.1%,总符合率为97.1%。RT-3D-TEE判断腱索断裂的准确性为99.3%;诊断瓣叶赘生物的准确性为100%。结论:二尖瓣脱垂的RT-3D-TEE表现具有特征性,RT-3D-TEE是诊断二尖瓣脱垂的有效手段,亦可以提供一些额外信息。     

Real-time transthoracic three-dimensional echocardiography provides additional information of left-sided AV valve morphology after AVSD repair

AIMS: The purpose of this study was to assess the feasibility of real-time 3D echocardiography (RT-3DE) data acquisition in adult patients after atrioventricular septal defect (AVSD) repair and to evaluate whether RT-3DE has additional value over 2D echocardiography, regarding morphology and function of the left-sided AV valve (LAVV). METHODS: Twenty consecutive patients with surgically corrected partial or complete AVSD were enrolled in this study. The 3DE data sets were acquired with the Hewlett-Packard Sonos 7500 echo system (Philips Medical Systems, Andover, MA, USA). Images were reviewed off-line with assistance of TomTec Echoview 5.2 software (TomTec Inc., Munich, Germany) by experienced observers. En face reconstructions, from, respectively, the ventricular and atrial view, were made to evaluate the LAVV morphology and motion. RESULTS: 3DE reconstruction of the LAVV was feasible in 17 of 20 patients (85%). Mean time of 3DE acquisition was 9+/-6 min. The quality of the 3DE images was optimal in 35%, good in 30%, sufficient in 20% and insufficient in 15%. Identification of the LAVV structures was importantly better facilitated from a ventricular view. Accurate identification of LAVV morphology was possible in all 17 patients (85%). Relationship of the LAVV and the abnormal position of the LVOT was easier to evaluate from the 3DE reconstructions than from 2D echo. CONCLUSION: This study demonstrate that RT-3DE is feasible in daily practice and provides new insight into the dynamic morphology of the left-sided AV valve and LVOT anatomy after AVSD repair.     

Left-sided congenitally unguarded tricuspid valve with congenitally corrected transposition of the great arteries: A rare diagnosis confirmed by three-dimensional echocardiography

Left-sided unguarded tricuspid valve disease with congenitally corrected transposition of the great arteries (ccTGA) is a rare cardiac malformation, only reported a few times in the literature. Two-dimensional echocardiography (2DE) uses standard views to diagnose tricuspid valve disease. Advanced imaging techniques, such as three-dimensional echocardiography, allow for simultaneous visualization of the tricuspid valve annulus and all leaflets. Three-dimensional echocardiography (3DE) may be useful in distinguishing unguarded tricuspid valve orifice from other forms of tricuspid valve disease.     

经胸实时三维超声心动图在房间隔缺损和室间隔缺损介入治疗中的应用

目的 :探讨实时三维超声心动图在房间隔缺损和室间隔缺损介入治疗中的应用价值。方法 :采用Philips公司Sonos75 0 0型超声心动仪 ,实时三维超声心动图技术 (real time 3 dimensionalechocar diography,RT 3DE) ,部分结合二维食管超声心动图 (transesophagealechocardiography ,TEE )及放射检查技术引导 12例先天性房间隔缺损 ,10例膜部室间隔缺损进行了经导管介入治疗手术。结果 :2 2例患者介入手术均获成功 ,术后无残余分流。RT 3DE对房、室间隔缺损的部位、大小、相对空间毗邻关系的判定均可获得比二维超声更丰富的数据信息 ,可靠性强。在引导介入手术中 ,无需全麻 ,操作简便 ,三维实时显像表现出良好的时间和空间分辨率 ,年龄限制少 ,一定程度上可减少放射应用剂量。术中实时测量三维距离 ,血流及多普勒技术的应用还受到技术制约。结论 :经胸RT 3DE作为无创心脏检查手段在引导房、室间隔缺损的介入手术中有肯定价值 ,并可望广泛应用于其他介入治疗 ,但其技术有一定的局限性仍需进一步改进     

Malformations of the tricuspid valve associated with Fallot's tetralogy. Apropos of a series of 224 surgically treated Fallot's tetralogies

This study was based on 7 children aged 20 months to 13 years with tetralogy of fallot (TOF) and tricuspid valve defects. Cases of endocardial cushion defects (8 cases of atrioventricular) were excluded. Three types of tricuspid valve defect were observed: 4 tricuspid valve prolapse (with one associated mitral valve prolapse); 2 accessory tricuspid valves passing through a ventricular septal defect to prolapse in diastole under the aortic valve; 1 Ebstein anomaly. The prevalence of tricuspid valve defects associated with TOF 3 p. 100 in this series. The diagnosis can: usually be made by 2D echocardiography. Tricuspid valve prolapse (usually the septal leaflet) is visualised in the apical 4 chamber view. The passage of accessory tricuspid tissue across the VSD into the left ventricular outflow tract is visible in the parasternal long axis or subcostal long axis views. Ebstein anomaly can be demonstrated in apical 4-chamber views showing the abnormally apical site of insertion of the septal leaflet of the tricuspid valve and "atrialisation" of part of the right ventricle. Tricuspid valve defects did not pose any special surgical problems during complete repair of TOF but this series did not include any cases of tricuspid hypoplasia or parachute tricuspid valve which have been reported in the literature and which do complicate surgery. Tricuspid valve and subendocardial cushion defects should be looked for systematically in patients with TOF undergoing 2D echocardiography.     

"照相法"对二尖瓣手术标本瓣口面积的测量

目的:探讨"照相法"测量二尖瓣手术标本瓣口面积(MVA)的方法.方法:在二尖瓣置换术患者20例术中取二尖瓣口标本并固定,用二维超声心动图(2DE)和实时三维超声心动图(RT-3DE)分别测量术前活体的MVA(MVA2DE和MVA3DE)、术后标本MVA(MVAOP2DE和MVAOP3DE).将标本置入已定标的模具并拍照获取瓣口"鸟瞰图".用软件测量"鸟瞰图"中标本MVA(MVAOP照).结果:MVAOP照与MVA2DE、MVA3DE、MVAOP2DE、MVAOP3DE均呈高度相关(r分别为0.84,0.89,0.94和0.94,P<0.05),且MVAOP照与其他标本MVA测值间差异无统计学意义(P>0.05).结论:"照相法"可简便、准确地测量二尖瓣手术标本MVA,为临床评价MVA提供了一种可靠的对照方法.