超声心动图和多平面经食管体元模型三维重建超声显像在经导管房间隔缺损闭合术中的应用

摘要

Objective To evaluate the feasibility and efficacy of the three-dimensional voxel imaging of multiplane transesophageal echocardiography in transcatheter closure of atrial septal defects(ASD).Methods The shapes and diameters of ASDs were measured in 30 patients with seoondum ASD by transthoracic echocardiography (TTE),transesophageal echocardiography(TEE),and three-dimensional voxel imaging(3D).The results were compared with those measured by intraoperative balloon.A1l of 30 patients received the transcatheter Closure under the guidance of TTE or TEE.Results The closure of AsDs were suceessfuHy performed in 23 patients.The accuracy of TEE for measuring ASD size was better than that of TTE(r=0.91 and r=O.85,respectively).The shape of ASD could be visualized in 18 patients either from left atrium(LA)or from right atrium(RA)after three-dimensional reconstruction.Sixteen of them were ellipses,and the other two were nearly circle.The exceHent correlation of ASD areas andthemaximum diameterswasobtainedbetween3Dand balloonmeasurements(γ=0.92,0.93,P<0.01,<0.001 for areaS from LA and RA respectively,and γ=0.88,P<0.01 for diameters).The maximum diameters of ASD by 3D were larger than those by balloon measures in 2 of them.No residual shunt were detected by echocardiographv immediately after the closure.The ASD diameters were too large to be closed by the occluders in 5 Datients.Conclusions Three-dimensional voxel imaging of multiplane transesophageal echocardiography are valuable in selecting appropriate patients,choosing suitable catheter sizes,displaying spacial positions of the occluders and detecting residual shunt.It plays an important role in assisting transcatheter closure of ASD.%目的 评价超声心动图和体元模型三维重建超声显像在经右心导管修补房间隔缺损中的价值.方法 30例继发孔型房间隔缺损患者,行经胸和(或)经食管超声心动图以及三维重建超声显像定量房间隔缺损的大小和形态,与经导管球囊注水测值相比较,并在超声心动图监测下行经右心导管修补术.结果 23例获得成功.经食管超声测定房间隔缺损大小的准确性较经胸超声显著提高,二者与球囊注水测值的相关性分别为γ=0.91和r=0.85.18例患者分别从右房和左房两个方向观察缺损的三维形态,16例为椭圆形,2例近似圆形,其面积和缺损的最大径与注水球囊高度相关(面积γ=0.92～0.93,P<0.01～0.001;最大径r=0.88,P<0.01).2例缺损的最大径大于球囊测值.超声在术中监测闭合器与房间隔平面的位置是保证手术成功的关键之一.结论 超声心动图和三维显像能够正确估测房间隔缺损位置、大小和形态,有利于术前的病例选择和正确选择闭合器的型号.超声在术中指导闭合器的放置和评价术后疗效,是该手术重要的监测手段.