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目的：应用实时三维超声心动图（RT-3DE）技术，并通过与二维超声心动图（2DE）比较，探讨其在诊断结构性心脏病中的应用价值。方法选取2009年10月至2014年2月在南昌大学第一附属医院住院的92例心脏病患者，全部患者进行RT-3DE检查，通过对感兴趣区病变结构三维图像进行切割及旋转后处理作出诊断，同时对房间隔缺损（ASD）及室间隔缺损（VSD）大小进行测量分析，以外科手术结果为金标准，对比2DE与RT-3DE在结构性心脏病诊断率的一致性和差异，评价RT-3DE准确性和优越性。结果（1） RT-3DE对92例心脏病患者均成功采集三维图像，对病变结构能立体、直观地从各个角度得到显示，正确诊断病变的部位、范围和程度及与邻近组织结构的空间位置关系，获得2DE无法得到的切面观，较2DE提供了更为直观而准确的信息。（2）在先天性心脏病中，RT-3DE诊断符合率与2DE相同；在瓣膜病及其他病变中，RT-3DE则稍高于2DE。（3）与2DE所测直径相比， RT-3DE所测ASD最大长轴径与手术结果具有更好的相关性（r值分别为0．94和0．86）；RT-3DE所测VSD最大长轴径与手术结果具有更好的相关性（r值分别为0．93和0．84）。结论 RT-3DE操作简便，成像速度快，在结构性心脏病的诊断中可获得比2DE更丰富的空间信息，提高了诊断正确率，可作为2DE的有益补充，在结构性心脏病外科手术方案的制定上具有指导意义。“,”Objective To explore the application value of real-time three-dimensional echocardiography (RT-3DE) in diagnosis of structural heart disease through a comparison with two dimensional echocardiography (2DE).Methods Ninety-two patients with heart disease were enrolled from October 2009 to February 2014 , all of whom were examined by RT-3DE.By cutting and spiraling structural 3D images of lesions in regions of interest , we made a diagnosis of lesions .In addition, the size of atrial(ASD) and ventricular septal defects (VSD),based on surgical results,was measured and analyzed.By comparing the coherence and difference of diagnosis on structural heart disease examined by 2DE and RT-3DE, the accuracy and superiority of RT-3DE were evaluated.Results (1)The 3D images of 92 patients with heart disease were successfully obtained by RT-3DE.The structure of lesions was displayed directly from various angles .In addition, the position, scope and degree of lesions and the spatial relationship of adjacent structures were accurately confirmed.RT-3DE provided more direct, accurate and abundant information than 2DE.(2)In the diagnosis of congenital heart disease, the diagnostic accordance rate of RT-3DE was the same as that of 2DE, but was slightly higher in the diagnosis of valvular disease and other lesions .( 3 ) Compared with 2DE, the ASD maximum diameters obtained from RT-3DE were more correlaed with surgical findings (r=0.94,0.86),so were the VSD maximum diameters (r=0.93, 0.84).Conclusion RT-3DE is easy to operate and quick to produce image ,which can provide more spatial information than 2DE in structural heart disease diagnosis , increase the accuracy rate of diagnosis , and serve as a supplement to 2DE.