实时三维超声心动图在三尖瓣下移畸形矫治术后右室重构评估中的应用

目的：探讨实时三维超声心动图（three-dimensional echocardiography，3DEcho）在三尖瓣下移畸形（Ebstein anomaly，EA）解剖矫治术后右室重构评估中的应用。方法：回顾性分析2015年10月至2022年08月期间在中国医学科学院阜外医院住院行外科矫治术治疗的22例EA患者临床资料、3DEcho及心脏磁共振（cardiac magnetic resonance，CMR）指标。结果：患者中位年龄30.7（14.1, 38.4）岁，中位随访时间22.9（6.5，35.6）月。3DEcho与CMR两种检查方法在基线右室舒张末容积指数（indexed right ventricular end-diastolic volume， RVEDVi）指标测值呈高度正相关(r = 0.908, P = 0.012)；基线右室射血分数（right ventricular ejection fraction, RVEF）(r = 0.621, P = 0.002)、术后RVEF (r = 0.567, P = 0.009) ，两者测值均呈中度正相关，有统计学意义。术后与术前基线状态相比较，三尖瓣反流程度减轻【术后反流程度≥中度者3例（13.6%）vs.术前≥中度者20例（90.9%），P<0.01】，RVEDVi较术前减小（98.4±54.8 vs. 188.5±114.5 ml/m2, P<0.01），差异有统计学意义；术后整组RVEF变化无统计学意义（术后 41.2±7.9% vs. 术前44.6±6.7%, P=0.215）。结论：3DEcho可准确评估EA患者右室容积及功能，并在术后随访评估右室重构中发挥重要作用。

Application of real-time three-dimensional echocardiography in the evaluation of right ventricular remodeling after correction of Ebstein anomaly

Objectives: Exploring the application of real-time three-dimensional echocardiography (3DEcho) in the evaluation of postoperative remodeling of right ventricle in Ebstein anomaly (EA). Methods: From October 2015 to August 2022, clinical data, 3DEcho, and cardiac magnetic resonance (CMR) imaging results of 22 consecutive EA patients who underwent surgical treatment were retrospectively studied in Fuwai hospital. Results: The median age of 22 patients was 30.7(14.1, 38.4) years. The median follow-up time was 22.9(6.5, 35.6) months. From 3DEcho, the indexed RV volumes was closely correlated with CMR imaging (r=0.908, P=0.012), the baseline right ventricular ejection fraction (RVEF) (r=0.621, P=0.002) and postoperative RVEF (r=0.567, P=0.009) were both moderately positively correlated and statistically significant. Compared with baseline, the degree of tricuspid regurgitation decreased (P<0.01), and the indexed RV volumes decreased (98.4±54.8 vs. 188.5±114.5 ml/m2, P<0.01), with a significant difference. There was no significant change in RVEF (postoperative 41.2±7.9% vs. baseline 44.6±6.7%, P=0.215).Conclusions: 3DEcho can accurately evaluate the RV volume and function of EA patients and play an important role in postoperative follow-up evaluation of right ventricular remodeling.