实时三维超声心动图在房间隔缺损诊治中的临床应用研究

目的评价实时三维超声心动图（RT-3DE）在继发孔型房间隔缺损（SASD）诊断和指导选择封堵器（ASO）型号中的临床应用价值.方法 37例先天性心脏病单纯SASD患者,术前均行二维经胸超声（TTE）、二维经食道超声（TEE）、实时三维经胸超声（RT-3D-TTE）和实时三维经食道超声（RT-3D-TEE）检查测量ASD最大值,将所得测值与ASO型号做对比.结果 36例患者完成所有超声检查,1例放弃TEE和RT-3D-TEE检查;36例患者成功接受经导管房间隔缺损封堵术（TCASD）治疗,1例因下腔静脉端残边缺如放弃封堵.术后即刻、3 d及3个月ASO位置固定,均未发现残余分流.RT-3D-TEE和TEE的ASD测值与ASO型号相关良好（相关系数r分别为0.754和0.692）,且前者高于后者.结论 RT-3D-TEE在术前指导ASO型号选择中作用显著,是协助TCASD的首选方法.

Clinical Application of Real-time 3-dimensional Echocardiography in Diagnosis and Treatment of Atrial Septal Defect

Objective To evaluate the clinical application of real-time 3-dimensional echocardiography（RT-3DE）in diagnosis of secundum atrial septal defects（SASD）and in the selectin of Amplatzer septal occluder（ASO）.Methods 37 patients with ASD were examined with transthoracic echocardiography（TTE）,transesophageal echocardiography（TEE）,real-time 3-dimensional transthoracic echocardiography（RT-3D-TTE）and real-time 3-dimensional transesophageal echocardiography（RT-3D-TEE）.The maximum sizes of ASD measured by each method were compared with the diameters of ASO repectively.Results 36 patients were examined by all the ultrasonic methods,1 quit from the TEE and RT-3D-TEE.36 cases were enrolled for transcatheter closure of atrial septal defect（TCASD）successfully,1 transferred for surgery because of its absent rim of IVC.No residual shunt was found immediately after the procedure,neither during 3 days to 3 months follow-up.All ASO were functioning well.There were correlations between diameters of ASO and sizes of ASD measured by RT-3D-TEE（r：0.754）and those by TEE（r：0.692）,and the former one was higher.Conclusion RT-3D-TEE plays a significant role in the selectin of ASO preoperation.It is a potentially valuable tool for TCASD.