实时三维超声心动图在主动脉窦瘤破裂诊断中的应用价值

目的探讨实时三维超声心动图在主动脉窦瘤定量诊断方面的优势。方法应用实时二维超声和实时三维超声（RT-3DE）对18例经二维超声诊断主动脉窦瘤破裂患者进行检查并将其实时三维超声立体图像处理，确定主动脉窦瘤位置形态、破裂口数量及破入方向；采用Q1AB软件测定窦瘤体积和基底部面积。结果18例患者中16例（16／18）为右冠状动脉窦瘤破裂，2例（2／18）无冠状动脉窦瘤破裂；9例破入右心室，6例入右心室流出道，3例破入右心房；16例（16／18）窦瘤破口为1个，仅2例（2／18）为2个或以上破口。瘤体体积（4．17±1．56）ml，基底部面积为（0．79±0．65）cm2。结论 RT-3DE能准确显示主动脉窦瘤位置、形态及破入方向，特别在确定破裂口数量、瘤体和破口大小方面有其优势，为临床正确选择治疗方法提供影像学资料。

The diagnostic value of real-time three-dimensional echocardiography in rupture of aneurysmal sinus

Objective To evaluate the diagnostic value of real-time three-dimensional echocardiography （RT-3DE） in rupture of aneurysmal sinus. Methods A total of 18 patients with rupture of aneurysmal sinus were examined using Philips iE33. Two dimensional （2D） and three dimensional （3D） characters were studied by two dimensional echocardiography （2DE） and RT-3DE, respectively. The sites and shapes of aneurysm were examined using RT-3DE. The number of the aneurysmal fistula was determined by RT- 3DE, as well as its sites of entry into the heart. Then the volume of aneurysm and the area of neck were analyzed using QLAB software. Results Sixteen cases were located in the right aortic sinus, while 2 cases were located in the noncoronary sinus. There were 9 cases of rupture into the right ventricle, 6 cases of rupture into the right ventricular outflow tract and 3 cases rupture into the fight atrium. One fistula was observed in 16 cases, while two or multiple fistulas in 2 cases. The volume of aneurysm was 4.17 ± 1.56 ml, and the neck area of aneurysm was 0.79 ± 0.65 cm2. Conclusion RT-3 DE can precisely identify the characteristics of rupture of aneurysmal sinus （ e. g. the sites and shapes of the aneurysm, the sites of entry into the heart, and the number of fistulas） especially in quantitative analyzing the volume of aneurysm and the neck area of aneurysm . RT-3DE plays an important role in providing powerful image data, which is helpful in treatment for the rupture of aneurysmal sinus in clinical practice.