Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, 123 Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
AJR Am J Roentgenol. 2009 Dec;193(6):1522-9. doi: 10.2214/AJR.09.2854.
The purpose of this study was to compare transthoracic echocardiography (TTE), cardiac CT, and transesophageal echocardiography (TEE) in the evaluation of secundum atrial septal defect (ASD) for closure with an Amplatzer septal occluder in pediatric patients.
The cases of 28 children with ASD initially diagnosed with TTE who were scheduled for cardiac CT for evaluation for insertion of an Amplatzer septal occluder under TEE guidance were reviewed. The patients were divided into a group with small ASD (long axis < 1.5 cm) and a group with large ASD (long axis > or = 1.5 cm). Measurements of the ASD obtained at TTE, cardiac CT, and TEE were compared. Kappa statistics were used to correlate the diagnostic value of cardiac CT assessed by two independent reviewers.
After cardiac CT, six patients were excluded from occluder implantation; therefore, 22 patients (seven boys, 15 girls; mean age, 4.95 years; range, 2-11 years) were included in the study. There were no significant differences in the ages and sexes of the patients in the two groups, but pulmonary-to-systemic blood flow ratio in the large-ASD group was significantly greater than that in the small-ASD group (3.54 +/- 1.43 vs 1.89 +/- 0.36; p = 0.001). With respect to long- and short-axis lengths of the ASD, interatrial septum, and four rims and to detection of rim deficiency, neither group had a significant difference between cardiac CT findings at ventricular end-systole and TEE findings. The long axis of the ASD in the large-ASD group measured at cardiac CT at end-systole and TEE was significantly longer than the long axis measured at TTE (p = 0.012). A high diagnostic score with good interobserver correlation (kappa = 0.674-0.750) validated the feasibility of cardiac CT in the assessment of ASD for closure with an Amplatzer septal occluder.
The long axis of a large ASD can be underestimated at TTE. Cardiac CT seems comparable with TEE in the assessment of ASD and is helpful in noninvasive evaluation for Amplatzer septal occluder implantation, especially for large ASD.
本研究旨在比较经胸超声心动图（TTE）、心脏 CT 和经食管超声心动图（TEE）在评估儿科患者使用 Amplatzer 房间隔缺损（ASD）封堵器闭合继发 ASD 中的作用。
回顾了 28 例最初通过 TTE 诊断为 ASD 的患儿，这些患儿计划在 TEE 引导下行心脏 CT 评估，以植入 Amplatzer 房间隔封堵器。将患者分为小 ASD 组（长轴<1.5cm）和大 ASD 组（长轴≥1.5cm）。比较 TTE、心脏 CT 和 TEE 测量的 ASD 值。采用 Kappa 统计分析两名独立观察者评估的心脏 CT 诊断价值。
心脏 CT 后，有 6 例患者被排除在封堵器植入之外；因此，共有 22 例患者（7 名男孩，15 名女孩；平均年龄 4.95 岁；范围 2-11 岁）纳入研究。两组患者的年龄和性别无显著差异，但大 ASD 组的肺循环与体循环血流量比值明显大于小 ASD 组（3.54±1.43 比 1.89±0.36；p=0.001）。在 ASD、房间隔的长轴和短轴长度以及四个边缘以及边缘缺陷的检测方面，两组在心室收缩末期心脏 CT 结果与 TEE 结果之间均无显著差异。大 ASD 组 ASD 的长轴在心脏 CT 收缩末期和 TEE 上的测量值明显大于 TTE 的测量值（p=0.012）。心脏 CT 评估 ASD 并使用 Amplatzer 房间隔缺损封堵器进行闭合的诊断评分较高，观察者间相关性较好（kappa=0.674-0.750），这验证了其可行性。
TTE 可能低估了大 ASD 的长轴。心脏 CT 似乎与 TEE 在 ASD 评估中具有可比性，并且有助于对 Amplatzer 房间隔缺损封堵器植入进行非侵入性评估，特别是对于大 ASD。
