eSie Valves三维自动定量分析在经导管主动脉瓣置换术前评估主动脉根部的应用价值  

Evaluation of a novel echocardiographic three-dimensional automated software for the assessment of the aortic root in candidates for transcatheter aortic valve replacement

作　　者：黄朝旭[1] 蒲朝霞[1] 夏向阳[1] 周丽明[1] 刘先宝[2] 何宇欣[2] 王建安[2] 何伟[3] 周琦晶[4] 

机构地区：[1]浙江大学医学院附属第二医院超声科,杭州310009 [2]浙江大学医学院附属第二医院心血管内科,杭州310009 [3]浙江大学医学院附属第二医院麻醉科,杭州310009 [4]浙江大学医学院附属第二医院放射科,杭州310009

出　　处：《中华超声影像学杂志》2017年第6期478-483,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨eSie Valves三维自动定量分析系统在经导管主动脉瓣置换术患者主动脉根部定量评估中的应用价值。方法18例外科手术高危的三叶式重度钙化性主动脉瓣狭窄行经导管主动脉瓣置换术患者，术前应用经食管三维超声心动图（3D-TEE），分别在四种模式下（Lax、Lax-Res、Sax、Sax—Res模式）采集主动脉根部三维图像，eSie Valves三维自动定量分析系统重建主动脉根部三维模型，自动测量主动脉瓣环最小径（Dmin）、最大径（Dmax）、面积（Area）、周长（Peri）及左右冠状动脉开口距离主动脉瓣环的高度（LOH／ROH），并与多层螺旋CT（MDCT）相应测值比较。结果eSie Valves分析系统局部放大模式（Sax-Res和Lax-Res模式）Dmin、Dmax、Area、Peri、LOH/ROH与MDCT相应测值差异均无统计学意义（均P2〉0．05）。Lax-Res模式主动脉瓣环平面相关测值与MDCT相应测值有良好的相关性（Lax-Res-Dmin：r=0．81，Lax-Res—Dmax：r=0．77，Lax-Res-Area：r=0．89，Lax-Res-Peri：r=0．84（均P〈0．05）。LOH／ROH与MDCT测值相关性弱（均r〈0．7）。结论eSie Valves三维自动定量分析系统可准确测量三叶式主动脉瓣环径线，推荐选用Lax-Res模式；该软件对冠脉开口高度测量尚不准确，仍需进一步改进。Objective To evaluate the accuracy of a novel echocardiographic three-dimensional automated software for the assessment of the aortic root in candidates for transcatheter aortic valve replaeement（TAVR）. Methods Four patterns（Lax, Lax-Res, Sax, Sax-Res） of 3D TEE imaging of aortic root were gotten preoperatively in 18 patients with severe tricuspid aortic stenosis who were referred to our center for TAVR. The specialized 3D-TEE reconstruction software, eSie Valves, then automatically configured a geometric model of the aortic root from the images obtained by 3DTEE and performed a quantitative analysis of these structures：the minimal diameter（Drain）, maximal diameter（Dmax）, area and perimeter（Pert） of aortic annulus, height of the ostia of the left/right coronary artery above the aortic annulus（LOH/ROH）. The echo dimensions were compared with the MDCT measurements. Results No statistically significant difference were found in above parameters between the ZOOM pattern （Sax-Res and Lax-Res） and CT measurements（all P 〉0.05）. Lax-Res pattern measurements had good correlation with MDCT, with r valves of 0.81,0.77, 0. 89, 0.84 for Lax-Res Dmin, Lax-Res-Dmax, Lax-Res Area, Lax-Res- Pert, respectively（all P〈0. 05）. 3D-TEE LOH/ROH had poor correlation with MDCT LOH/ROH （all r〈0.7）. Conclusions The new automatic 3D-TEE software allows modelling and quantifying the aortic annulus dimensions from 3D-TEE data in patients with tricuspid aortic valves, and Lax Res pattern is recommended. Quantified assessment of LOH/ROH is not ideal and needs to be improved.

关 键 词：超声心动描记术 经食管 经导管主动脉瓣置换术 主动脉瓣狭窄 

分 类 号：R540.45[医药卫生—心血管疾病]