CAJ | 학술논문

目的：探讨常规及经胸实时三维超声心动图在Ebstein畸形诊断中的应用价值。方法2007年3月至2014年7月拟在阜外心血管病医院外科手术矫治Ebstein畸形患者61例，同时采集门诊正常成人20例作为对照。常规超声及经胸实时三维超声评价右心室大小、功能及三尖瓣反流。常规超声分析参数包括右心室前后径（RV）、三尖瓣环横径（TV-R）、反流分级及瓣叶下移距离。经胸实时三维超声检查测量计算右心室舒张末容积（EDV）、右心室收缩末容积（ESV）、右心室舒张末容积指数（EDVI）、右心室收缩末容积指数（ESVI）、右心室每搏量（SV）、三尖瓣环面积（TV-A）、三尖瓣反流口血流束横截面积（EROA）。结果经胸实时三维超声心动图可立体显示三尖瓣对合面、瓣环大小及瓣叶立体结构。61例患者中仅32例获得完整右心室容积数据，余29例采集右心室三维图像不完整。三尖瓣反流5级（重度）34例（55.7%）；4级（中重度）16例（26.2%）；，3级（中度）11例（18.1%），平均（4.4±0.7）级。与正常成人比较，Ebstein畸形患者右心室EDV、ESV、EDVI、ESVI、SV、RV、TV-R 明显增大[（273.5±77.7）ml vs（74.3±15.9）ml，（187.1±96.8）ml vs（31.1±9.2）ml，（177.4±53.6）ml/m2 vs（43.4±8.2）ml/m2，（121.7±65.5）ml/m2 vs（18.4±5.1）ml/m2，（95.9±20.2）ml vs（43.6±8.8）ml，（48.1±13.3）ml/m2 vs（19.0±1.9）ml/m2，（56.4±8.9）ml/m2 vs（28.5±4.3）ml/m2]，差异有统计学意义（P均＜0.05）；右心室射血分数（EF）明显减低[（38.3±12.8）%vs（59.3±5.1）%，P=0.000]；EROA与RV、RV/LV显著相关（r=0.6910、0.6471，P均＜0.05）。结论经胸实时三维超声可显示Ebstein畸形患者三尖瓣的瓣叶畸形特征和右心室功能，作为常规超声的重要补充，为临床诊断及功能评估提供依据。
목적：탐토상규급경흉실시삼유초성심동도재Ebstein기형진단중적응용개치。방법2007년3월지2014년7월의재부외심혈관병의원외과수술교치Ebstein기형환자61례，동시채집문진정상성인20례작위대조。상규초성급경흉실시삼유초성평개우심실대소、공능급삼첨판반류。상규초성분석삼수포괄우심실전후경（RV）、삼첨판배횡경（TV-R）、반류분급급판협하이거리。경흉실시삼유초성검사측량계산우심실서장말용적（EDV）、우심실수축말용적（ESV）、우심실서장말용적지수（EDVI）、우심실수축말용적지수（ESVI）、우심실매박량（SV）、삼첨판배면적（TV-A）、삼첨판반류구혈류속횡절면적（EROA）。결과경흉실시삼유초성심동도가입체현시삼첨판대합면、판배대소급판협입체결구。61례환자중부32례획득완정우심실용적수거，여29례채집우심실삼유도상불완정。삼첨판반류5급（중도）34례（55.7%）；4급（중중도）16례（26.2%）；，3급（중도）11례（18.1%），평균（4.4±0.7）급。여정상성인비교，Ebstein기형환자우심실EDV、ESV、EDVI、ESVI、SV、RV、TV-R 명현증대[（273.5±77.7）ml vs（74.3±15.9）ml，（187.1±96.8）ml vs（31.1±9.2）ml，（177.4±53.6）ml/m2 vs（43.4±8.2）ml/m2，（121.7±65.5）ml/m2 vs（18.4±5.1）ml/m2，（95.9±20.2）ml vs（43.6±8.8）ml，（48.1±13.3）ml/m2 vs（19.0±1.9）ml/m2，（56.4±8.9）ml/m2 vs（28.5±4.3）ml/m2]，차이유통계학의의（P균＜0.05）；우심실사혈분수（EF）명현감저[（38.3±12.8）%vs（59.3±5.1）%，P=0.000]；EROA여RV、RV/LV현저상관（r=0.6910、0.6471，P균＜0.05）。결론경흉실시삼유초성가현시Ebstein기형환자삼첨판적판협기형특정화우심실공능，작위상규초성적중요보충，위림상진단급공능평고제공의거。
ObjectiveTo explore the value of conventional echocardiography and transthoracic real-time three-dimensional echocardiography (RT3DE) in diagnosis of Ebstein anomaly.MethodsWe investigated the morphology and function of right ventricle (RV) as well as the structure, morphology and regurgitation of tricuspid valve in 61 adult patients with Ebstein anomaly before surgery by using conventional echocardiography and transthoracic RT3DE. Twenty normal adults were enrolled as control group. ResultsThe surface of the tricuspid leaflets, the morphology of the tricuspid annulus as well as the three-dimensional structure of the tricuspid valve were displayed stereoscopically by RT3DE. Complete RV volume data could be acquired in 32 patients of Ebstein anomaly. The apex or part of RV could not be contained in the remaining 29 patients. Thirty-four (55.7%) patients with Ebstein anomaly had severe tricuspid regurgitation, <br> 16 (26.2%) patients had moderate to severe regurgitation, and 11 (18.1%) patients had moderate regurgitation. Compared with the normal adults, patients of Ebstein anomaly showed higher RV end-diastolic volume (EDV), end-systolic volume (ESV), end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume (SV), RV anterior-posterior diameter (RV), tricuspid valve annular transverse diameter (TV-R), and lower RV ejection fraction(EF) [(273.5±77.7) mlvs (74.3±15.9) ml, (187.1±96.8) mlvs (31.1±9.2) ml, (177.4±53.6) ml/m2vs (43.4±8.2) ml/m2, (121.7±65.5) ml/m2vs (18.4±5.1) ml/m2, (95.9±20.2) ml vs (43.6±8.8) ml, (48.1±13.3) ml/m2vs (19.0±1.9) ml/m2, (56.4±8.9) ml/m2vs (28.5±4.3) ml/m2, (38.3±12.8) %vs (59.3±5.1) %, allP<0.05). The tricuspid regurgitant orifice flow cross-sectional area (EROA) were correlated positively with RV anterior-posterior diameter (r=0.691), ratio of RV and LV anterior-posterior diameter (RV/LV) (r=0.6471).ConclusionTransthoracic RT3DE is a feasible method in addition to conventional two-dimensional echocardiography in evaluation of tricuspid valve mophology and function, as well as RV volume and EF in adult patients with Ebstein anomaly.