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Assessment of Atrial Septal Defect-Role of Real-Time 3D Color Doppler Echocardiography for Interventional Catheterization

心房中隔缺損:即時三度立體空間彩色杜卜勒超音波在介入性心導管的處置評估

摘要


背景 傳統上,人們由二維平面心臟超音波影像看,易認為心房中隔缺損是一個圓孔,即使外科醫師也沒有辦法得知心房中隔缺損的真實型態,因為外科醫師所見到的心房中隔缺損是處在一個沒有跳動、而且塌陷的心臟狀態;相對地,小兒心臟專科醫師施行介入性心導管時,得對一個跳動中的心臟置放關閉器,因此需要知道確實的心房中隔缺損型態。這個研究的目的,是用最新進的即時三度立體空間彩色杜卜勒超音波,來評估心房中隔缺損型態和做為選擇心房中隔缺損關閉器大小依據的可行性。 材料與方法 在西元2003年二月至十二月之間,總共有十二名第二型心房中隔缺損的病人在介入性心導管治療時,同時接受了二維平面經食道超音波和即時三度立體空閒彩色杜卜勒超音波檢查,包含氣球導管測量的缺損直徑跟超音波影像,都被仔細的紀錄下來,並加以分析。 結果 十二位年紀從3歲到36歲(平約11.6±8.2歲)的病人,都成功地接受介入性心導管治療。肺循環對體循環血流分流比率平約是2.4±1.9(範圍:1.6-4.5),心房中隔缺損關閉器的平約大小是23.1±9.2公厘(範圍:7-36公厘),氣球導管測量的平約缺損直徑大小是19.9±7.6公厘(範圍:6.0-34.1公厘),二維平面經食道超音波所量測的平約缺損直徑大小是19.2±7.1公厘(範圍:5.4-33.5公厘),三度立體空問彩色杜卜勒超音波所量測的平均缺損直徑大小是21.2±9.0公厘(範圍:6.1-34.5公厘)。即時三度立體空閒彩色杜卜勒超音波顯示心房中隔缺損不是一個平坦的圓洞,它是一個立體形狀,有著曲折邊緣的缺損。這些曲折邊緣在不同的方向有不同程度的曲度,因此形成了一個複雜的空間結構。沿著缺損的長軸所計算出來的曲度平約是166±5.4度。關閉器大小與三種測量心房中隔缺損直徑之間有著良好的關聯性,相關性如下:與氣球導管量測的直徑(r=0.995)、與二維平面經食道超音波量測直徑(r=0.987)、與三度立體空閒彩色杜卜勒超音波量測直徑(r=0.997)。關閉器大小與三度立體空間彩色杜卜勒超音波量測直徑有著最佳的關聯性(r=0.997)。 結論 在跳動的心臟中,只有即時三度立體空間彩色杜卜勒超音波才能正確地描述心房中隔缺損的複雜立體型態,傳統的二維平面影像只能提供部分資訊,並扭曲了心房中隔缺損的型態評估,因此即時三度立體空間彩色杜卜勒超音波提供介入性心導管時,置放心房中隔缺損關閉器的一個有用工具。

並列摘要


Background: Atrial septal defect (ASD) is easily thought to be a round hole in the atrial septum from the image of two-dimensional (2D) echocardiography. Even surgeons can not get the true morphology of an atrial septal defect because they only see the defect when the heart is already in a collapsed, non-beating condition. Pediatric interventional cardiologists, on the contrary, need to know the exact morphology in the beating heart so that a therapeutic device can be safely deployed. The purpose of this study was to evaluate the accuracy of real-time three-dimensional echocardiography (RT-3D Echo) in visualizing the morphological characteristics of ASD and its potential as a new method for selecting the size of the Amplatzer septal occluder. Materials and Methods: Between February 2003 and December 2003, a total of 12 patients with secundum-type ASD underwent simultaneously 2D transesophageal echocardiography (TEE) and RT-3D Echo during interventional catheterization. The stretched balloon diameter, 2D TEE images, and RT-3D Echo images were recorded and analyzed in detail. Results: Twelve patients, aged from 3.0 to 36.0 years (mean 11.6±8.2 years), safely underwent the interventional catheterization. The mean Qp/Qs was 2.4±1.9 (range 1.6-4.5). The mean size (waist) of the 12 devices was 23.1±9.2 mm (range 7-36 mm). The mean SBD was 19.9±7.6 mm (range 6.0-34.1 mm). The mean 2D-TEE ASD measurement was 19.2±7.1 mm (range 5.4-33.5 mm). The mean RT-3D ASD measurement was 21.2±9.0 mm (range 6.1-34.5 mm). Analyses of the RT-3D Echo imaging showed that the ASD is not a flat hole in the septum. The ASD curves in three dimensions. The curvature varied differently in different directions, thus generating a complex spatial structure. The calculated curvature angles along long axis of defects were 166±5.4 degrees. Good correlations were found between device diameter (waist) and SBD (r=0.995), 2D diameter (r=0.987), and 3D diameter (r=0.997). The best correlation was found between device diameter (waist) and 3D diameter measured by planimetry of RT-3D Echo (r=0.997). Conclusions: The complex 3D nature of the ASD in the beating heart could only be well appreciated by the RT Color 3D Echo. The conventional 2D image provided only partial and thus distorted image of ASD. Thus, the application ofRT-3D Echo provides a useful tool for evaluation of ASD for those patients undergoing interventional transcatheter closure.

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