Diagnosis of Ebstein anomaly with conventional and transthoracic real-time three-dimensional echocardiography

doi:10.3877/cma.j.issn.1672-6448.2015.04.008

Abstract

Abstract:

Objective

To explore the value of conventional echocardiography and transthoracic real-time three-dimensional echocardiography (RT3DE) in diagnosis of Ebstein anomaly.

Methods

We investigated the morphology and function of right ventricle (RV) as well as the structure, morphology and regurgitation of tricuspid valve in 61 adult patients with Ebstein anomaly before surgery by using conventional echocardiography and transthoracic RT3DE. Twenty normal adults were enrolled as control group.

Results

The surface of the tricuspid leaflets, the morphology of the tricuspid annulus as well as the three-dimensional structure of the tricuspid valve were displayed stereoscopically by RT3DE. Complete RV volume data could be acquired in 32 patients of Ebstein anomaly. The apex or part of RV could not be contained in the remaining 29 patients. Thirty-four (55.7%) patients with Ebstein anomaly had severe tricuspid regurgitation, 16 (26.2%) patients had moderate to severe regurgitation, and 11 (18.1%) patients had moderate regurgitation. Compared with the normal adults, patients of Ebstein anomaly showed higher RV end-diastolic volume (EDV), end-systolic volume (ESV), end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume (SV), RV anterior-posterior diameter (RV), tricuspid valve annular transverse diameter (TV-R), and lower RV ejection fraction(EF) [(273.5±77.7) ml vs (74.3±15.9) ml, (187.1±96.8) ml vs (31.1±9.2) ml, (177.4±53.6) ml/m² vs (43.4±8.2) ml/m², (121.7±65.5) ml/m² vs (18.4±5.1) ml/m², (95.9±20.2) ml vs (43.6±8.8) ml, (48.1±13.3) ml/m² vs (19.0±1.9) ml/m², (56.4±8.9) ml/m² vs (28.5±4.3) ml/m², (38.3±12.8) % vs (59.3±5.1) %, all P<0.05). The tricuspid regurgitant orifice flow cross-sectional area (EROA) were correlated positively with RV anterior-posterior diameter (r=0.691), ratio of RV and LV anterior-posterior diameter (RV/LV) (r=0.6471).

Conclusion

Transthoracic RT3DE is a feasible method in addition to conventional two-dimensional echocardiography in evaluation of tricuspid valve mophology and function, as well as RV volume and EF in adult patients with Ebstein anomaly.

Key words: Echocardiography, three-Dimensional, Tricuspid valve, Heart diseases

Yong Jiang, Hao Wang, Minjie Lu, Linyuan Wan, Wugang Wang, Minghui Zhang, Weichun Wu, Xin Sun. Diagnosis of Ebstein anomaly with conventional and transthoracic real-time three-dimensional echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(04): 288-295.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2015.04.008

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Figures/Tables 6

References 14

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项目	常规超声（二维、彩色多普勒成像）	三维超声
右心室采集完整性	一般为100%	仅52.5%采集到完整右心室容积
图像采集切面	分别采集心尖四腔心、右心室流入道、大动脉短轴切面	一次采集右心室容积图像
观察前叶活动度	单一平面观察瓣叶是否冗长，活动度	立体显示前叶形态，显示瓣叶与游离壁间簇状腱索
显示瓣叶对合面	不易获得，仅部分病例可以显示短轴	易获得三个瓣叶短轴对合面及对合间隙
三尖瓣反流	需要多个切面显示反流束，半定量反流分级	可准确测量反流口面积
三尖瓣环分析	内径测量	面积测量

项目	常规超声（二维、彩色多普勒成像）	三维超声
右心室采集完整性	一般为100%	仅52.5%采集到完整右心室容积
图像采集切面	分别采集心尖四腔心、右心室流入道、大动脉短轴切面	一次采集右心室容积图像
观察前叶活动度	单一平面观察瓣叶是否冗长，活动度	立体显示前叶形态，显示瓣叶与游离壁间簇状腱索
显示瓣叶对合面	不易获得，仅部分病例可以显示短轴	易获得三个瓣叶短轴对合面及对合间隙
三尖瓣反流	需要多个切面显示反流束，半定量反流分级	可准确测量反流口面积
三尖瓣环分析	内径测量	面积测量

组别	例数	女性比例	年龄（岁）	体表面积（m²）	EDV（ml）	ESV（ml）
Ebstein组	32	62.5%	31.6±14.4	1.55±0.13	273.5±77.7	187.1±96.8
正常对照组	20	60.0%	32.3±12.7	1.63±0.16	74.3±15.9	30.1±9.2
t值	?	?	0.439	1.889	14.047	9.107
P值	?	?	0.663	0.065	0.000	0.000
组别	EDVI（ml/m²）	ESVI（ml/m²）	EF（%）	SV（ml）	RV（mm）	TV-R（mm）
Ebstein组	177.4±53.6	121.7±65.5	38.3±12.8	95.9±20.2	48.1±13.3	56.4±8.9
正常对照	43.4±8.2	18.4±5.1	59.3±5.1	43.6±8.8	19±1.9	28.5±4.3
t值	13.666	8.867	-8.303	12.831	12.225	15.212
P值	0.000	0.000	0.000	0.000	0.000	0.000

组别	例数	女性比例	年龄（岁）	体表面积（m²）	EDV（ml）	ESV（ml）
Ebstein组	32	62.5%	31.6±14.4	1.55±0.13	273.5±77.7	187.1±96.8
正常对照组	20	60.0%	32.3±12.7	1.63±0.16	74.3±15.9	30.1±9.2
t值	?	?	0.439	1.889	14.047	9.107
P值	?	?	0.663	0.065	0.000	0.000
组别	EDVI（ml/m²）	ESVI（ml/m²）	EF（%）	SV（ml）	RV（mm）	TV-R（mm）
Ebstein组	177.4±53.6	121.7±65.5	38.3±12.8	95.9±20.2	48.1±13.3	56.4±8.9
正常对照	43.4±8.2	18.4±5.1	59.3±5.1	43.6±8.8	19±1.9	28.5±4.3
t值	13.666	8.867	-8.303	12.831	12.225	15.212
P值	0.000	0.000	0.000	0.000	0.000	0.000

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