目的 探讨单心动周期实时三维经胸超声心动图在小儿房间隔缺损诊疗中的应用价值。方法 应用GE Vivid E9超声诊断仪、M5S广角及4V-D四维探头对27例先天性房间隔缺损(atrial septal defect,ASD)患者,3～15岁,平均(9.0±5.5)岁,进行常规二维经胸超声及单心动周期实时三维超声经胸心动图检查,明确诊断。并对缺损大小进行测量分析,将二维、三维测量值与手术结果对照。结果 单心动周期实时三维超声心动图能从多个视角,模拟手术路径立体显示房间隔全貌,包括缺损的整体形态、部位、大小,以及毗邻关系;实时三维超声、二维超声同手术结果相对比:测量ASD最大长轴径分别为(29.7±7.3)mm、(33.6±9.2)mm、(31.2±9.2)mm ,实时三维超声较二维超声与手术结果具有更好的相关性(r分别为0.96,0.82)。结论 单心动周期实时三维经胸超声心动图能够模拟手术野,为ASD的测量提供了准确可靠的新方法,具有重要的临床应用潜力。

Objective To study the clinical value of single cardiac cycle real-time three dimensional transthoracic echocardiography (RT3DE) in the diagnosis and treatment of atrial septal defect in children. Methods GE Vivid E9 ultrasound system and a M5S wide-angle or a 4V-D (4D cardiac) probe were applied in 27 patients with congenital atrial septal defect (ASD) to perform conventional two-dimensional transthoracic echocardiography (2DE) and single cardiac cycle RT3DE and to make the diagnosis and assess the size and location of the defects. The findings of 2D and RT3D echocardiography were compared with surgical results. Results Single cardiac cycle RT3DE stereoscopically displayed atrial septum simulating surgical view from multiple perspectives, including overviews of the shape, position, size, and proximity of defects. ASD maximal diameters measured by RD3DE (29.7±7.3) mm had better correlations (r=0.96, r=0.82, respectively) with surgical measurements(31.2±9.2) mm than by 2DE(33.6±9.2) mm. Conclusions Single cycle RT3DE can simulate surgery views and provide a new approach for accurate and reliable the measurement of ASD, so it has important potential for clinical applications.