即時三度立體心臟超音波應用於心房中隔缺損測量之研究

The Effect of Transthoracic Real-Time Three-Dimensional Echocardiography for measuring Atrial Septal Defect

廖仲斌(Chung-Pin Liao)

指導教授 ： 李怡靜

中山醫學大學/醫學院/醫學研究所/碩士(2007年)

https://doi.org/10.6834/CSMU.2007.00123

摘要

心房中隔缺損（Atrial Septal Defect, ASD）在先天性心臟病中，屬於常見疾病之一，尤其在成年人的先天性心臟病當中，發生率更是首居第一。傳統對於心房中隔缺損的治療方法是以開心手術為主，但近幾年介入性心導管治療的進步，使用心房中隔關閉器（Amplatzer Septal Occulder, ASO）治療心房中隔缺損已成為一種可以被接受的治療方式。在成功執行心房中隔關閉術時，準確的評估心房中隔缺損大小及周邊組織的情況是主要的關鍵；目前測量心房中隔缺損大小，以球囊測量導管（Balloon Stretched Diameter, BSD）的結果為黃金指標。但隨著超音波發展，即時三度立體心臟超音波（Real-Time Three-Dimensional Echocardiography, RT-3DE）可完整的呈現心房中隔缺損完整的立體空間結構，已成為臨床上先天性心臟病的有效診斷工具。
本篇研究旨在應用即時三度立體心臟超音波對心房中隔缺損的大小做為評估的主要方法，做進一步探討；再者使用其結果找出更有效及準確的心房中隔缺損大小測量方法，以利介入性心房中隔關閉術的成功進行。
樣本對象：50位繼發孔型心房中隔缺損（Secundum type ASD）的病人，併有右側心臟血流負荷過重（Volume overloading）的症狀，準備接受心房中隔關閉術的治療。
方法：在50位病人中，使用即時三度立體心臟超音波針對心房中隔缺損最大值的前後徑、上下徑、圓周及面積進行測量，其結果與球囊測量導管的測量數值進行二者間的線性迴歸分析，以瞭解二者數值間的關係；在二者中找出較好的正相關值，進而試著找出即時三度立體心臟超音波在心跳週期中的最佳測量方法。
結果：在50組資料分析後，即時三度立體心臟超音波的四組ASD最大值測量結果中，以圓周演算直徑與球囊測量導管最能呈現顯著的正相關（Y=0.996x+4.313, r=0.841）；依據圓周測量結果為基準，來探討心跳循環中的準確性，其結果發現平均的圓周演算直徑相較於最大與最小圓周的演算直徑而言，與球囊測量導管的結果呈現更高的相關性（Y=0.790x+3.59, r=0.908）。最後所有50位病人皆完成心房中隔關閉術的診斷。
結論：在心房中隔缺損病人中，使用即時三度立體心臟超音波測量時，以心房中隔缺損的圓周演算直徑與球囊測量導管測量結果呈現高度正相關；而就整個心跳週期中，取最大及最小圓周的平均值圓周演算直徑的結果，比以最大或最小的圓周演算直徑結果更為準確。

關鍵字

心房中隔缺損 ； 氣球測量導管 ； 即時三度立體心臟超音波 ； 心房中隔關閉器

並列摘要

Atrial septal defect（ASD） is one of the most frequent lesions in congenital heart disease especially in adult. Surgical repair of an ASD is a low-risk and widely accepted procedure. In near years, ASD transcatheter occlusion techniques have become an alternative to surgical procedure. Then, ASD size measurement is paramount importance for the successful deployment of a transcatheter septal occulder（ASO）. Until now, the balloon stretched diameter（BSD）has long been regarded as the gold standard for selection size of any device. Be along with echocardiography development, real-time three-dimensional echocardiography（RT-3DE）accurately defined ASD location, size, and surrounding atrial anatomy.
The study aim was to compare the BSD and RT-3DE methods to measure the ASD size. Further, to use these results to get the greater method of measurement in the cardiac cycle.
Population: The fifty heart failure patients referred for transcatheter closure of a secundum ASD were enrolled.
Method: In all fifty patients, maximal diameter of the defect including: antero-posterior, supero-inferior, derived from circumference, and derived from area measurement were performed in each patients when the defect hole appeared mazimal in size during the cardiac cycle. Then, comparing these data and BSD measurement, and finding the best correlation in these datas of RT-3DE. Finally, in the best correlation data, to find the good measurement in the cardiac cycle.
Result: After statistical analysis, RT-3DE measurement of diameter derived from circumference agreed well with the BSD （Y=0.996x+4.313, r=0.841）. In this data, the mean diameter derived from circumference agreed well with the BSD （Y=0.790x+3.59, r=0.908）. Transcatheter closure was pergormed successfully in fifty patients using the Amplatzer device closure.
Conclusion: In these patients with ASD, RT-3DE measurement of diameter derived from circumference was high correlation with BSD. In the heart cycle, mean diameter derived from circumference more agreed well with the BSD than maximum and minimum diameter derived from circumference. If we will find the best measurement of the ASD size, we need have more research and clinical experience.

並列關鍵字

atrial septal defect ； balloon stretched diameter ； real-time three-dimensional echocardiography ； transcatheter septal occulder

參考文獻

5. Myung K. Park MD. Pediatric Cardiology For Practitioners. 3th ed. American: Year Book Medical; 1996.

3. Hugh D. Allen HPG, Edward B. Clark, David J. Driscoll. Moss and Adams' heart disease in infants, children, and adolescents: including the fetus and young adult. 6th ed. Philadelphia; 2001.

6. A. Rebecca Snider MD, Gerald A. Serwer, M.D., Samuel B. Ritter, M.D. Echocardiography in Pediatric Heart Disease. 2nd ed. American: Anne S. Patterson; 1997.

7. Lilliam M. Valdes-Cruz MD, Raul O. Cayre, M.D. Echocardiographic Diagnosis of Congenital Heart Disease. 1st ed. Philadelphia: Raven; 1999.

8. Edward Y. Lee M, MPH Marilyn J. Siegel, MD Celeste M. Chu, MD Fernando R. Gutierrez, MD Henry W. Kort, MD. Amplatzer Atrial Septal Defect Occluder for Pediatric Patients: Radiographic Appearance. Radiology. 2004;233(2):471-476.