婴儿复杂型先天性心脏病的三维超声诊断  

A methodological study of three-dimensional echocardiography for the diagnosis of complex congenital heart malformations in infants

作　　者：孙锟[1] 陈树宝[1] 江海[1] 张玉奇[1] 高玲玲[1] 倪金洪[1] 郝名华[1] 沈蓉[1] 郁怡[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心小儿心内科,200092

出　　处：《中华儿科杂志》2001年第7期401-405,W001,共6页Chinese Journal of Pediatrics

基　　金：国家自然科学基金 (3 970 0 15 2 );上海市教委曙光计划 (98SG40 );上海市青年科技启明星计划资助项目 (97QB14 0 17)

摘　　要：目的　初步评价婴儿复杂型先天性心脏病 (简称先心病 )二维超声心动图信息采集及三维超声诊断新方法的临床应用价值。方法　复杂型先心病婴儿 2 4例 ,男 11例 ,女 13例 ;年龄 (7± 5 )个月。其中肺静脉与心房连接异常 5例、房室连接异常 5例、心室大血管连接异常 9例、混合畸形 5例。应用婴儿复杂型先心病三维超声心动图二维超声信息采集方法及剖视诊断方案进行诊断 ,并与二维超声心动图诊断结果比较 ,以心导管造影或手术中诊断为标准进行评价。结果　 1/ 2 4例 (4 % )未能成功进行三维采样。 15 / 2 3例 (6 5 % )能提供主要阳性诊断的详细空间信息 ,尤其对心室构型判断、心室大血管连接关系及房室间隔缺损分型意义较大 ;2 / 2 3例 (9% )纠正了二维超声心动图诊断并经手术或心导管造影证实 ;6 / 2 3例 (2 6 % )未能较二维超声心动图提供更多有用信息。结论　新的二维图像采集、重建及剖视诊断方案能基本满足婴儿复杂型先心病的三维诊断要求 ,比二维超声心动图能提供更丰富直观的空间诊断信息 。Objectives A serial studies by the authors have demonstrated that optimal results could be easily achieved by setting X and Y resolution of 2D images at 100%, using 3.5 MHz transducer, rotating transducer every 1° through subcostal or apical window during two-dimensional echocardiographic image acquisition and setting opacity and threshold by 30 and 20, respectively, during three-dimensional (3D) reconstruction in infants. Ten new designed 3D echocardiographic section views could demonstrate the detailed spatial information of complex congenital heart malformations in heart specimen with complex congenital heart disease. This study attempted to evaluate the new three-dimensional echocardiographic acquisition of 2D images and 3D echocardiographic reconstruction method for 3D vivi-sectional diagnosis of complex congenital heart malformations in infants. Method Twenty-four cases of infants including 5 cases of abnormal pulmonary venous and atrial connection, 5 cases of abnormal atrial-ventricular connection, 9 cases of ventricular-great artery connection and 5 cases of mixed heart malformations were diagnosed by the new designed three-dimensional echocardiographic method and by using HP SONOS 1000 echocardiographic system interfaced with TOMTEC image system. The results were compared with the results of 2D echocardiography. Angiocardiography and/or post-operative diagnosis was served as 'gold standards'. Results Three-dimensional reconstruction was successfully performed in 23 of 24 infants with complex congenital heart malformation. Additional information was provided in 15 of 23 patients (65%). The ventricular configuration identification, aorta septal continuity and the classification of atrial ventricular defect (AVSD) were more significant by using the new three-dimensional echocardiographic method. In 2/23 patients (9%), 2D echocardiographic diagnosis was corrected by 3D echocardiography and confirmed by angiocardiography and the operation. One of the two cases with transposition of great artery was misdi

关 键 词：婴儿 心脏缺损 先天性 超声心动描记术 

分 类 号：R725.4[医药卫生—儿科]