实时三维超声心动图对先天性心室肌致密化不全的诊断价值  

The role of real-time three dimensional echocardiography in assessing congenital noncompaction of ventricular myocardium

作　　者：马晓静[1] 黄国英[1] 梁雪村[1] 吴琳[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海200032

出　　处：《中国循证儿科杂志》2007年第2期121-125,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的应用实时三维超声心动图（RT3DE）诊断儿童先天性心室肌致密化不全（NCVM），初步评价其应用价值。方法2006年7至12月应用二维超声心动图诊断为NCVM的患儿4例，其中女性3例，男性1例，年龄2～11个月。采用RT3DE观察心脏肌小梁和隐窝的形态，计算左室射血分数，根据时间-容量曲线参数对左室同步性进行评价。结果①RT3DE对NCVM的形态观察：1例累及整个左室，3例累及左室中段和心尖部。②RT3DE对NCVM的量化诊断：收缩末期最大肌小梁顶部至心外膜表面距离与隐窝底部至心外膜表面距离的比值（X’s／Y’s）为3．3～5．0；舒张末期最大肌小梁顶部至心外膜表面距离与隐窝底部至心外膜表面距离的比值（X’d／Y’d）为2．6～4．4。③RT3DE对NCVM的心功能评价：左室射血分数为21．2％～56．4％。@RT3DE对NCVM的左室同步性评价：所有16个心肌节段到达每一个节段收缩期最小容量时间的标准差在心动周期中所占的比例为2．65％～19．30％，最大差值在心动周期中所占比例为8．75％～78．20％。结论RT3DE不仅能够观察NCVM累及的范围，而且可以定量评价其严重程度，测定心功能以及评价同步化运动。Objective To evaluate the preliminary value of real-time three dimensional echocardiography （RT3DE） in diagnosing congenital noncompaction of ventricular myocardium （NCVM） in children. Methods Four cases of NCVM diagnosed by two dimensional echocardiography in Children＇s Hospital of Fudan University from July 2006 to December 2006 were included. RT3DE was used to observe the structure of trabecula and recess and calculate the ejection fraction of left ventricle. Left ventricular synchronicity was assessed by the parameters from time-volume curve. Results （1） NCVM morphology observed by RT3DE： According to Van Praagh sequential analysis method, all of the four cases were single NCVM without combining cardiac anomaly. Four-chamber volumetric view showed left ventricle was involved entirely in one case while the middle part and apex of left ventricle were implicated in the other three cases. But in no case right ventricle was involved. （2） Quantitative diagnosis of NCVM by RT3DE ： From ventricular short axis volumetric view, the non-compacted myocardial layers at the end of systole （X＇s） were 1.0 - 2.0 cm, while the compacted myocardial layers （Y＇s） were 0.3 - 0.4 cm in length. So the ratio of non-compacted to compacted myocardial layers at the end of systole （X＇s/Y＇s） was 3.3 - 5.0. The non-compacted myocardial layers at the end of diastole （ X＇ d） were 1.1 - 2.2 cm, while the compacted myocardial layers （Y＇d） were 0.4 - 0.5 cm. So the ratio at the end of diastole （ X＇d/ Y＇d） was 2.6 -4. 4. Whether at the end of systole or at the end of diastole, the ratioes of non-compacted to compacted myocardial layers were all more than 2. （3） Left ventricular systolic function of NCVM assessed by RT3DE： The left ventricular diastolic volume was 15.1 -44.0 mL, while the systolic volume was 7.8 - 22.8 mL. So the left ventricular ejection fraction was 21.2% - 56.4%. Cardiac function of all cases was compromised in different degrees. （4） Left ventricular synch

关 键 词：心室肌致密化不全 超声心动描记术 实时 三维显像 

分 类 号：R725.4[医药卫生—儿科]