经胸实时三维超声心动图指导房间隔缺损封堵器选择

目的 评价经胸实时三维超卢心动图(RT-3DE)指导房间隔缺损(ASD)封堵器选择的临床应用价值.方法 30例ASD患者,术前应用二维经胸超声心动图观测ASD大小及周缘情况,RT-3DE及彩色RT-3DE观察ASD形态,测量ASD面积及最大径,并计算出圆形面积代换内径.封堵器释放后测量其面积及腰径.结果 ASD以非类圆形为主22例(73.3%).在各种ASD形态中,封堵器释放后腰部形态仍为类圆形,其面积与RT-3DE及彩色RT-3DE所测量ASD面积差异无统计学意义(P>0.05).二维测量ASD内径小于封堵器释放后腰径,RT-3DE测量ASD最大内径大于封堵器释放后腰径,但圆形面积代换内径与封堵器释放后腰径差异无统计学意义(P>0.05).ASD圆形面积代换内径与封堵器大小(Y=0.29+1.132 X,r=0.93,P<0.0001)及释放后封堵器腰径(Y=一0.160+1.063 X,r=0.98,P<0.0001)显著相关.所有患者ASD封堵器牢固无脱落.结论 经胸RT-3DE在指导ASD封堵器选择中有肯定价值.

Value of transthoracic real-time three dimensional echocardiography on selecting occluder of atrial septal defect

Objective To evaluate clinical application of transthoraeic real time three-dimensional echocardiography(RT-3DE) on selecting oecluder of the atrial septal defect(ASD). Methods ASD size and its rim of thirty patients with ASD were measured by transthoracic two-dimensional echoeardiography(2DE) on various views before occlusion. ASD was reconstructed by transthoracic RT-3DE and color RT-3DE. The images were studied in multiple orientations and cross sections, including the morphology, area, longest diameter,and cycloidal dimension of substitution (CDS) was calculated. The waist size of occluder was measured after releasing oecluder. Results Among 30 eases of ASD, there were 22 cases(73.3 %) with non-round like defects. In various morphous of ASD,the waist morphology of occluder still was round-like after releasing oeeluder. There was no significant difference between waist area of occluder and measured area of ASD by RT-3DE and color RT-3DE. All ASD diameters measured by 2DE were smaller than the dimension of waist after releasing, ASD longest diameters measured by RT-3DE and color RT-3DE were larger than the dimension of waist after releasing,but were no significant differences with CDS. Significant correlation was existed between the CDS of ASD measured by RT-3DE and the size of selected occluder (Y = 0.29 + 1.132 X , r = 0.93, P<0.0001), and the waist size of released occluder(Y = - 0.160 + 1.063 X , r = 0.98, P 0.0001). Oceluder was firmly fixed without falling off in all patients. Conclusions Transthoracic RT-3DE has certain value on selection of ASD occluder.