目的 评价实时三维经食管超声心动图(RT-3DTEE)在临床治疗特殊类型房间隔缺损(ASD)风险评估中的应用价值.方法 对57例特殊类型ASD患者分别通过二维经胸超声心动图(2DTTE)、二维经食管超声心动图(2DTEE)及RT-3DTEE进行术前评估.观察ASD相关声像图表现,并对比三者对临床治疗的指导作用.结果 57例特殊类型ASD中,采用2DTTE及2DTEE对46例可清晰显示ASD的形态和数目,对其余11例仅能诊断ASD为不规则或两孔可,而RT-3DTEE对57例均可直观显示ASD形态和数目.采用2DTTE、2DTEE及RT-3DTEE测量收缩末期左心房横径(LATD)、右心房横径(RATD)、右心室舒张末期内径(RVDD)、左心室舒张末期内径(LVDD)差异均无统计学意义(P均＞0.05);测量ASD的最大径(ASDD)时,2DTEE与2DTTE、RT-3DTEE与2DTTE差异均有统计学意义(P均＜0.05).3种方法测量ASD上腔静脉侧、主动脉侧及心房顶侧的残边长度总体差异均无统计学意义(P均＞0.05);3种方法测量ASD下腔静脉侧残边长度总体差异有统计学意义(F=50.39,P＜0.001),两两比较差异均有统计学意义(P均＜0.05).通过RT-3DTEE对57例均可指导ASD治疗方式,而2DTTE对5例不能确定,2DTEE对2例不能确定.结论 RT-3DTEE可提供丰富的影像诊断信息,对特殊类型ASD治疗的风险评估具有重要指导意义.%Objective To evaluate the application value of real-time three-dimensional transesophageal echocardiography (RT-3DTEE) for the risk assessment of unusual atrial septal defect (ASD) in clinic therapy.Methods Accurate assessment before operation was conducted in 57 cases of patients with unusual ASD by two-dimensional transthoracic echocardiography (2DTTE),two-dimensional transesophageal echocardiography (2DTEE) and RT-3DTEE.The ultrasound manifestations were observed.And the guidance in clinic therapy were compared.Results The shape and number can be displayed clearly by 2D-TTE and 2D-TEE in 46 of 57 eases.Another 11 cases were diagnosed as irregular or two holes possibly.RT-3DTEE can help to observe the morphology and quantity of ASD visually and comprehensively in all cases.There was no statistical difference among 2DTTE,2DTEE and RT-3DTEE for the measurement of right atrium end-systolic transverse diameter (RATD),left atrium end-systolic transverse diameter (LATD),right ventricular end-diastolic diameter (RVDD) and left ventricular end-diastolic diameter (LVDD;all P＞0.05).The statistic difference for the diameter of atrial septal defect (ASDD) was found between 2D-TEE and 2D-TTE (P＜0.05) and RT-3DTEE and 2D-TTE (P＜0.05).There was no statistical difference among 2D-TEE,2DTTE and RT-3DTEE for the measurement of residual boundary condition of superior vena cava,aorta side and the top side of the atrium (all P＞0.05),whereas significant difference was found in measuring the residual boundary condition of inferior vena cava (F=50.39,P＜0.001).There were statistic differences between 2DTEE and 2DTTE,RT-3DTEE and 2DTTE,RT-3DTEE and 2DTEE (all P＜0.05).The clinic therapy can be directed by RT-3DTEE in all 57 cases.The diagnosis of 5 cases was failed by 2D-TTE,and 2 cases was failed by 2D-TEE.Conclusion Abundant image information can be offered by RT-3DTEE which plays an important role in the risk assessment of unusual atrial septal defect.
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