Jiang Guo-Ping, Gao Li-Chao, Gong Fang-Qi, He Jin, Ye Jing-Jing
Department of Ultrasonography, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Pediatr Cardiol. 2014 Feb;35(2):270-5. doi: 10.1007/s00246-013-0768-3. Epub 2013 Aug 8.
This study aimed to investigate the reference point for the downward displacement of the posterior and anterior leaflets of the tricuspid valve using echocardiography in children with Ebstein's anomaly. This study enrolled 25 patients with Ebstein's anomaly. The extent of downward displacement of the posterior and anterior leaflets of the tricuspid valve was evaluated by echocardiography using the tricuspid annulus and the coronary sinus as reference points. These results were compared with the surgical findings. The findings showed displacement of the simple septal leaflet in 1 patient, displacement of both the septal and posterior leaflets in 22 patients, displacement of both the anterior and posterior leaflets in 1 patient, and displacement of all the leaflets in 1 patient. Because the septal and posterior leaflets were close to the apex or because the posterior leaflet was nearly absent, the displacement distance of the septal and posterior leaflets could not be measured accurately in two patients. The displacement distance of the septal and posterior leaflets in the remaining 22 patients were 2.08 ± 1.15 and 2.58 ± 1.06 cm, respectively. The displacement distances of the anterior leaflet in two patients were respectively 1.0 and 2.2 cm. These results were similar to those measured during surgery. The direction of the valvular regurgitation flow was anterolateral in the apical four-chamber and apical right heart two-chamber views in patients with the downward displacement of the anterior leaflet. The tricuspid valve annulus and the coronary sinus are ideal reference points for evaluating the downward displacement of the posterior and anterior leaflets of the tricuspid valve. It is critical to evaluate the downward displacement of the anterior leaflet that the direction of the tricuspid regurgitation flow is changed.
本研究旨在利用超声心动图研究埃布斯坦畸形患儿三尖瓣前后叶向下移位的参考点。本研究纳入了25例埃布斯坦畸形患者。以三尖瓣环和冠状窦为参考点，通过超声心动图评估三尖瓣前后叶向下移位的程度。将这些结果与手术发现进行比较。结果显示，1例患者单纯隔叶移位，22例患者隔叶和后叶移位，1例患者前叶和后叶移位，1例患者所有瓣叶移位。由于隔叶和后叶靠近心尖或后叶几乎缺失，2例患者中隔叶和后叶的移位距离无法准确测量。其余22例患者中隔叶和后叶的移位距离分别为2.08±1.15和2.58±1.06cm。2例患者前叶的移位距离分别为1.0和2.2cm。这些结果与手术测量结果相似。在前叶向下移位的患者中，心尖四腔心和心尖右心两腔心视图中瓣膜反流的方向为前外侧。三尖瓣环和冠状窦是评估三尖瓣前后叶向下移位的理想参考点。评估前叶向下移位时，三尖瓣反流方向的改变至关重要。
