Kasliwal Ravi R, Chouhan Nagendra S, Sinha Ashish, Gupta Pankaj, Tandon Sharad, Trehan Naresh
Escorts Heart Institute and Research Centre, New Delhi.
Indian Heart J. 2005 Mar-Apr;57(2):128-37.
Complex anatomy of intra-cardiac structures requires spatial orientation of image in three dimensions for better understanding and enhanced image interpretation. We evaluated the feasibility and efficacy of the emerging 'real-time three-dimensional transthoracic echocardiography' technique for comprehensive assessment of cardiac anatomy, physiology, pathomorphology and pathophysiology in patients with structural heart disease.
Patients with structural heart disease (n=152) were evaluated by conventional two-dimensional transthoracic echocardiography and real-time three-dimensional transthoracic echocardiography using standard protocol. Fifty-six cases were of rheumatic etiology with multi-valvular involvement (mitral stenosis: 32; mitral regurgitation: 29; tricuspid regurgitation: 8; aortic valve disease: 11) and 21 cases of non-rheumatic valvular heart disease. A total of 38 congenital heart disease patients were examined including 23 patients with atrial septal defect. Left ventricular function (n=20) and right ventricular function (n=10) were also assessed using dedicated software.
Results of real-time three-dimensional transthoracic echocardiography mitral valve area assessment by planimetery are comparable to two-dimensional transthoracic echocardiography with additional information about surface anatomy of leaflets and the subvalvular apparatus in real time with clear demarcation of commissural fusion and scallops of leaflets. Enface view of atrial septal defect with direct visualization of shape, size and number of defects, tricuspid valve area by planimetery, right ventricular shape, objective assessment of ventricular volumes and regurgitation vena contracta area are the fields where three-dimensional transthoracic echocardiography was of additive value to conventional two-dimensional transthoracic echcardiography. This study proves clinical feasibility of real-time three-dimensional transthoracic echocardiography but requires further validation of quantitative observations.
心脏内部结构的复杂解剖需要对图像进行三维空间定位，以便更好地理解和增强图像解读。我们评估了新兴的“实时三维经胸超声心动图”技术在全面评估结构性心脏病患者心脏解剖、生理、病理形态和病理生理方面的可行性和有效性。
采用标准方案，对152例结构性心脏病患者进行了传统二维经胸超声心动图和实时三维经胸超声心动图评估。56例为风湿性病因，累及多个瓣膜（二尖瓣狭窄：32例；二尖瓣反流：29例；三尖瓣反流：8例；主动脉瓣疾病：11例），21例为非风湿性瓣膜性心脏病。共检查了38例先天性心脏病患者，其中23例为房间隔缺损患者。还使用专用软件评估了左心室功能（20例）和右心室功能（10例）。
通过面积测量法进行实时三维经胸超声心动图二尖瓣面积评估的结果与二维经胸超声心动图相当，同时还能实时提供有关瓣叶表面解剖和瓣下结构的额外信息，清晰界定瓣叶连合融合和扇贝状结构。实时三维经胸超声心动图在房间隔缺损的正面视图中可直接观察缺损的形状、大小和数量，通过面积测量法测量三尖瓣面积，观察右心室形状，客观评估心室容积和反流瓣口面积，这些方面对传统二维经胸超声心动图具有附加价值。本研究证明了实时三维经胸超声心动图的临床可行性，但定量观察结果还需要进一步验证。
