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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (12) : 887 -892. doi: 10.3877/cma.j.issn.1672-6448.2016.12.003

所属专题： 文献；

心血管超声影像学

二维、三维经食管超声心动图在经导管主动脉瓣植入术中的应用价值
潘翠珍1, 舒先红1, 周达新2, 潘文志2, 赵维鹏1, 孔德红1, 罗红3, 葛均波2,†()   
  1. 1. 200032　复旦大学附属中山医院上海市心血管病研究所心超室
    2. 200032　复旦大学附属中山医院上海市心血管病研究所心内科
    3. 200032　复旦大学附属中山医院上海市心血管病研究所麻醉科
  • 收稿日期:2016-03-27 出版日期:2016-12-01
  • 通信作者: 葛均波

The application value of real-time two-dimensional and three-dimensional transesophageal echocardiography in transcatheter aortic valve implantation

Cuizhen Pan1, Xianhong Shu1, Daxin Zhou2, Wenzhi Pan2, Weipeng Zhao1, Dehong Kong1, Hong Luo3, Junbo Ge2,†()   

  1. 1. Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
    2. Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
    3. Department of Anesthesia, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
  • Received:2016-03-27 Published:2016-12-01
  • Corresponding author: Junbo Ge
  • About author:
    Corresponding author: Ge Junbo, Email:
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引用本文：

潘翠珍, 舒先红, 周达新, 潘文志, 赵维鹏, 孔德红, 罗红, 葛均波. 二维、三维经食管超声心动图在经导管主动脉瓣植入术中的应用价值[J]. 中华医学超声杂志（电子版）, 2016, 13(12): 887-892.

Cuizhen Pan, Xianhong Shu, Daxin Zhou, Wenzhi Pan, Weipeng Zhao, Dehong Kong, Hong Luo, Junbo Ge. The application value of real-time two-dimensional and three-dimensional transesophageal echocardiography in transcatheter aortic valve implantation[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(12): 887-892.

目的

探讨二维、三维经食管超声心动图在经导管主动脉瓣植入术（TAVI）中的应用价值。

方法

对2010年5月至2015年10月在复旦大学附属中山医院行TAVI的11例重度主动脉瓣狭窄[主动脉瓣狭窄口面积<1.0 cm2，主动脉瓣口最大流速>4 m/s，平均跨瓣压差>40 mmHg（1 mmHg=0.133 kPa）]和1例人工生物主动脉瓣中重度反流患者术前均行常规经胸超声心动图检查及二维、三维经食管超声心动图检查（2DTEE、3DTEE），术中二维、三维经食管超声心动图监测，术后常规经胸超声心动图随访。采用Pearson相关分析分析3DTEE与计算机断层扫描（MDCT）评价主动脉瓣环最大值、最小值、瓣环面积以及狭窄口面积的相关性及3DTEE、MDCT与连续性方程评价狭窄口面积的相关性。

结果

所有患者均成功植入人工生物主动脉瓣，其中1例患者术中发现心脏压塞合并升主动脉夹层分离，经心包穿刺以及升主动脉夹层分离保守治疗3 d后突发心脏压塞死亡。所有患者MDCT与3DTEE评价主动脉瓣环最大径、最小径、瓣环面积及狭窄口面积的相关性均较好（r=0.98、0.97、0.97、0.99，P均<0.01）；术前连续性方程测量的主动脉狭窄口面积与MDCT及3DTEE评价结果的相关性均很好（r值均为0.99，P均<0.01）。

结论

2DTEE、3DTEE能快速、准确地定量主动脉瓣环的大小及评价主动脉的解剖结构，能实时引导和监测经导管主动脉瓣植入及其并发症。

关键词: 经导管主动脉瓣植入术, 超声心动描记术，经食管, 超声心动描记术，三维
Objective

To investigate the value of two-dimensional and three-dimensional transesophageal echocardiography (3DTEE) in transcatheter aortic valve implantation (TAVI).

Methods

Eleven patients with severe aortic stenosis and one patient with moderate to severe prosthetic valve regurgitation underwent TAVI in Zhongshan Hospital of Fudan University from May 2010 to December 2015. All patients received two-dimensional and three-dimensional transthoracic and transesophageal echocardiographic examination before surgery, during and after surgery.

Results

Procedural success was achieved in eleven patients, but one patient died in pericardial tamponade and aortic dissection three days after TAVI. The maximum and minimum diameter of aortic annule, the area of aortic annule and aortic valve were measured by multidetector computed tomography (MDCT) and 3DTEE before surgery. All parameters had strong correlations between MDCT and 3DTEE (r=0.98, P<0.01 for maximum diameter; r=0.97, P<0.01 for minimum diameter; r=0.97, P<0.01 for the area of aortic annule; r=0.99, P<0.01 for the area of aortic valve). There were good correlations for the area of aortic valve among MDCT, 3DTEE and equation of continuity (all r=0.99, P<0.01).

Conclusion

Two-dimensional and three dimensional transesophageal echocardiography can quantify the size of aortic annular and comprehensively evaluate the anatomical structure of aorta rapidly and accurately, which can be used in guiding TAVI and monitoring its complications in real time.

Key words: Transcatheter aortic valve implantation, Echocardiography, transesophageal, Echocardiography, three-dimensional
图1 经食管三维超声心动图立体显示二叶式主动脉瓣的形态。箭头示瓣上钙化结节
图3~5 三维经食管超声心动图定量主动脉瓣环的最大径及最小径（图3）、主动脉瓣环面积（图4）、主动脉狭窄口面积（图5）
图6、7 实时三维经食管超声心动图左心室长轴切面清晰显示输送导管。图6为带标尺导管（箭头所示）；图7为超硬导丝（箭头所示）
表1 所有患者术前、术后超声指标比较（±s）
时间 例数 LAD（mm） LVDD（mm） LVDS（mm） LVEF（%） AS-Vmax（m/s） ASPGmax（mmHg） ASPGmean（mmHg） ASA（cm2）
术前 12 42.58±5.68 49.83±5.50 34.00±5.00 59.15±5.30 5.06±0.62 103.25±22.87 57.50±13.00 0.70±0.24
术后 12 42.66±4.77 49.00±4.67 32.17±2.69 61.67±5.88 2.26±0.35 21.58±6.75 10.70±3.37 2.02±0.29
t值 ? -0.29 -1.07 2.34 2.08 11.93 10.23 9.23 6.52
P值 ? >0.05 >0.05 <0.05 <0.05 <0.01 <0.01 <0.01 <0.01
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