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目的 评价超声心动图和体元模型三维重建超声显像在经右心导管修补房间隔缺损中的价值。方法 30例继发孔型房间隔缺损患者 ,行经胸和 (或 )经食管超声心动图以及三维重建超声显像定量房间隔缺损的大小和形态 ,与经导管球囊注水测值相比较 ,并在超声心动图监测下行经右心导管修补术。结果 2 3例获得成功。经食管超声测定房间隔缺损大小的准确性较经胸超声显著提高 ,二者与球囊注水测值的相关性分别为r= 0 .91和r =0 .85。 18例患者分别从右房和左房两个方向观察缺损的三维形态 ,16例为椭圆形 ,2例近似圆形 ,其面积和缺损的最大径与注水球囊高度相关 (面积 r=0 .92～ 0 .93 ,P <0 .0 1～ 0 .0 0 1;最大径 r =0 .88,P<0 .0 1)。 2例缺损的最大径大于球囊测值。超声在术中监测闭合器与房间隔平面的位置是保证手术成功的关键之一。结论 超声心动图和三维显像能够正确估测房间隔缺损位置、大小和形态 ,有利于术前的病例选择和正确选择闭合器的型号。超声在术中指导闭合器的放置和评价术后疗效 ,是该手术重要的监测手段。
Objective To evaluate the value of echocardiography and voxel three-dimensional reconstructed ultrasound in the repair of atrial septal defect via right heart catheterization. Methods The size and shape of atrial septal defect were measured in 30 patients with atrial septal defect after transthoracic and / or transesophageal echocardiography and three-dimensional reconstruction ultrasonography, which were compared with those of transcatheter balloon infusion Echocardiographic monitoring was performed via right heart catheterization. Results 23 cases were successful. The accuracy of transesophageal echocardiography in determining the size of atrial septal defect was significantly higher than that of transthoracic ultrasound. The correlation between them and the measurement of infusing balloon was r = 0.91 and r = 0.85, respectively. 18 patients were observed from the right atrium and left atrium two directions, respectively, the three-dimensional morphology of defects, 16 cases were oval, 2 cases were approximately circular, the maximum diameter of the area and defect and water injection balloon height (area r = 92 ~ 0.93, P <0.01 ~ 0.010; the maximum diameter r = 0.88, P <0.01). Two cases of defect diameter greater than the maximum balloon measured. Ultrasound intraoperative monitoring of the position of the closer and atrial septal plane is one of the keys to successful operation. Conclusion Echocardiography and three-dimensional imaging can correctly estimate the location, size and shape of atrial septal defect, which is conducive to the preoperative choice of cases and the correct choice of the type of the occluder. Ultrasound guiding the placement of the occluder during operation and evaluating the postoperative efficacy are important monitoring methods for this operation.