实时三维超声心动图在房缺封堵术中的应用

目的探讨实时三维超声心动图(RT3DE)技术在经导管房间隔缺损(ASD)封堵术中的应用价值。方法57例连续先心病ASD行介入封堵治疗患者术前、术中及术后行经胸超声心动图(TTE)、经食管超声心动图(TEE)及RT3DE,测定ASD部位、大小、形态、以及与二尖瓣、三尖瓣的关系,术后封堵器的位置、形态、和残余漏。结果RT3DE显示ASD大多为不规则椭圆状。与TTE比较,RT3DE测得ASD最大径(P<0.05),ASD边缘与二尖瓣距离(P<0.01)及三尖瓣距离(P<0.05)差异有统计学意义。RT3DE在检测封堵后残余分流、封堵器对瓣膜活动影响及封堵器微脱位都优于TTE。结论RT3DE可准确测定ASD部位、大小、形态、以及与邻近解剖结构的关系,对封堵器选择、手术过程指导及术后疗效评价都非常有价值。

The application of real-time three-dimensional echocardiography in percutaneous closure atrial septal defect

Objective To evaluate the clinic value of real-time three-dimensional echocardiography (RT-3DE) in percutaneous closure atrial septal defect(ASD). Methods RT-3DE,trans-thorax echocardiography (TTE) and transesophageal echocardiography(TEE) was used to measure the sizes, shapes and sites of ASD and space between ASD and mitral valve, tricuapid valve in 57 ASD patients before and after closure opration, and measure the position, shapes, of occluder, and discovered residual-shunt in post-operation. Results RT-3DE showed that most secundum ASDs were approximately ellipse. Three were significant difference measurement between RE-3DE and TTE in maximal diameter of ASD(P<0.05), the distance of defect edge to annulus of mitral valve (P<0.01)and to annulus of tricuspid valve (P<0.05). RT-3DE can display clearly residual-shunt and occluder device affected the activity of valves. Conclusion RT-3DE may accurately measure the sites,sizes, shapes of ASD and display clearly anatomic relationship adjacent to ASD, and has important clinic value in selection of occluder divice, guiding intervention ASD and evaluation of theraputic effect.