CAJ | 학술논문

目的探讨经食管实时三维超声心动图(RT-3D TEE)在指导室间隔缺损(VSD)封堵器大小选择中的应用价值.方法 60例单纯VSD患者,三维组30例,术中应用RT-3D TEE采集VSD三维全容积图像或实时三维局部放大动态图像,测量心动周期中VSD最大面积、最小面积以及最大径,根据最大面积获得具有相似腰部面积的封堵器直径,在此直径基础上加1~2 mm作为所选用封堵器的大小;同时多角度采集VSD二维图像,测量缺损大小.二维组30例,术中应用经食管超声心动图(TEE)于心脏四腔或五腔观、左心室长轴以及大动脉短轴观测量缺损大小,在最大径基础上加1~2 mm作为所选用封堵器的大小.结果 RT-3D TEE观察VSD形状具有多态性.RT-3D TEE测量心动周期中VSD最大面积与最小面积差异有统计学意义(P<0.01).RT-3D TEE所测VSD最大径与同组二维测量最大径差异有统计学意义(P<0.01).三维组术后即刻未出现残余分流及封堵器移位,术中变更封堵器大小3次,封堵成功平均需 1.10 次(33/30);二维组因即刻出现残余分流致封堵失败2例,封堵成功者术中变更封堵器大小12次,封堵成功平均需 1.43 次(40/28),差异有统计学意义(P<0.01).结论 RT-3D TEE 能准确反映VSD的形态及大小,有助于封堵器大小的选择.
목적 탐토경식관실시삼유초성심동도(RT-3D TEE)재지도실간격결손(VSD)봉도기대소선택중적응용개치.방법 60례단순VSD환자,삼유조30례,술중응용RT-3D TEE채집VSD삼유전용적도상혹실시삼유국부방대동태도상,측량심동주기중VSD최대면적、최소면적이급최대경,근거최대면적획득구유상사요부면적적봉도기직경,재차직경기출상가1~2 mm작위소선용봉도기적대소;동시다각도채집VSD이유도상,측량결손대소.이유조30례,술중응용경식관초성심동도(TEE)우심장사강혹오강관、좌심실장축이급대동맥단축관측량결손대소,재최대경기출상가1~2 mm작위소선용봉도기적대소.결과 RT-3D TEE관찰VSD형상구유다태성.RT-3D TEE측량심동주기중VSD최대면적여최소면적차이유통계학의의(P<0.01).RT-3D TEE소측VSD최대경여동조이유측량최대경차이유통계학의의(P<0.01).삼유조술후즉각미출현잔여분류급봉도기이위,술중변경봉도기대소3차,봉도성공평균수 1.10 차(33/30);이유조인즉각출현잔여분류치봉도실패2례,봉도성공자술중변경봉도기대소12차,봉도성공평균수 1.43 차(40/28),차이유통계학의의(P<0.01).결론 RT-3D TEE 능준학반영VSD적형태급대소,유조우봉도기대소적선택.
Objective To evaluate the usefulness of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in the perventricular device occlusion of the ventricular septal defect (VSD).Methods Sixty patients underwent perventricular device occlusion of VSD were divided into two groups.Group A:30 patients,3D images of VSD were obtained intraoperatively by RT-3D TEE.3D images were analyzed and the maximal and minimum area and maximal diameter of VSD were measured in the cardiac cycle.The size of selected VSD occluder was the diameter calculated from the maximal area based on the formula πD2/4 and plus 1～2 mm.Simultaneously,two dimensional transesophageal echocardiography (2D TEE) images of VSD were obtained and measured on standard views.Group B:other 30 patients,intraoperative 2D TEE was performed to measure the diameter of VSD on standard views.The selection VSD occluder was based on the maximal diameter plus 1～2 mm.Results The VSDs shape showed oval,class round and irregular by RT-3D TEE imaging.There was a significant difference between the maximal area and smallest area of VSD appeared in the cardiac cycle obtained by RT-3D TEE (P<0.01).There was a significant difference between the maximal diameter by measurement of RT-3D TEE and 2D TEE (P<0.01).Of all 30 patients with evaluation of VSD size based on the RT-3D TEE,1.1 times attempts of device occlusion were performed on one patient (33/30).Of the other 30 cases with evaluation of VSD size by 2D TEE,2 cases were failed with device occlusion because of instant residual shunt.Of the remaining 28 cases,1.43 attempts of device occlusion were performed on one patient (40/28).Conclusions RT-3D TEE can accurately reveal the size of VSD,and aid in the selection of VSD occluder in the device occluding procedure of VSD.