实时三维超声心动图评价机械瓣形态和功能的初步研究

目的：评价实时三维超声（RT-3DE）技术观察人工机械瓣形态和功能的可行性、准确性,并探讨RT-3DE的优越性及其临床应用价值。方法：50例行二尖瓣和（或）主动脉瓣位机械瓣置换的患者,应用RT-3DE的灰阶成像和彩色成像模式,观察机械瓣和支架的形态结构,并通过与TTE检查结果对照,评价其相关血流动力学改变。结果：①RT-3DE灰阶成像对二尖瓣位上人工机械瓣和支架结构形态及其空间立体关系成像清晰率为92.6%（25/27）;对人工主动脉瓣的成像清晰率则为56.5%（13/23）;对二尖瓣合并主动脉瓣置换的患者,人工二尖瓣的三维成像清晰率为73.3%（11/15）;②RT-3DE彩色血流成像可较敏感地显示人工机械瓣的反流与瓣周漏。RT-3DE与TTE观察机械瓣反流与瓣周漏的吻合程度较高（Kappa值分别为0.72、0.74,P〈0.001）;Spearman相关系数分别为0.72、0.89,均P〈0.001。结论：RT-3DE的灰阶和彩色成像模式可准确、直观地反映人工机械瓣的形态结构和功能变化,较TTE能够提供更多的三维解剖结构和血流信息,是TTE的重要补充。

ASSESSMENT OF MECHANICAL PROSTHETIC VALVES WITH REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY

Objective：To evaluate the possibility and accuracy of real-time three-dimensional echocardiography（RT-3DE） in the assessment of the mechanical prosthetic valve apparatus＇s configuration and function in patients with prosthetic valves replacement,and to explore its superiority and the clinical value.Methods：RT-3DE and TTE were used to observe the structure,neighbor relationship of artificial valve and its bracket,and evaluate hemodynamic changes in fifty patients experienced the mitral valve（MV） replacement or/ and aortic valve（AV） replacement separately.Results：①92.6%（25/27） patients with MV replacement,56.5%（13/23） patients with AV replacement,MV in 73.3%（11/15） patients with MV and AV replacement could be successfully observed by gray-scale RT-3DE.②color RT-3DE could be used to assess the valve regurgitation and the leakage around the mechanical prosthetic valve.The outcome of RT-3DE method and TTE method is rather consistent,the Kappa value of judgment by the two methods was 0.72 in the valve regurgitation,and 0.74 in the perivalvular leakage,respectively（P〈0.001）,and the Spearman correlation value was 0.72 and 0.89,respectively（P〈0.001）.Conclusion：Mechanical posthetic valve apparatus＇s structure,motion and the flow dynamics could be accurately detected by RT-3DE.Compared with transthoracic echocardiography（TTE）,RT-3DE can provide more additional information of anatomic structure and hemodynamics.