Paediatric Cardiology Unit, Children's Hospital, Toulouse University Hospital, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
Arch Cardiovasc Dis. 2013 Oct;106(10):492-500. doi: 10.1016/j.acvd.2013.06.049. Epub 2013 Sep 23.
Accurate evaluation of aortic root geometry is necessary in congenital aortic valve lesions in children, to guide surgical or angiographical intervention.
To compare aortic annulus diameters measured by two- and three-dimensional transthoracic echocardiography (2D- and 3D-TTE), to determine the feasibility and reproducibility of 3D imaging and assess the dynamic changes during the cardiac cycle.
Thirty children without heart disease were prospectively included. Two orthogonal aortic annulus diameters were measured offline using multiplanar reconstruction in diastole and in systole and were compared with the measurement of the aortic annulus diameter by 2D-TTE.
Mean age was 11±3.6 years. Feasibility of 3D imaging was 100%. The coefficients of intra- and interobserver variability were 3.5% and 6%, respectively. The 2D mean diameter was significantly smaller than the 3D maximum diameter in systole (1.94 vs. 2.01mm; p=0.005). 2D and 3D measurements were well correlated (p<0.0001). The maximum and minimum diameters in 3D were significantly different both in systole and in diastole (p<0.001) underlining an aortic annulus eccentricity. The mean aortic annulus diameters were not significantly different between systole and diastole, with important individual variability during the cardiac cycle.
This study demonstrated the feasibility and reproducibility of 3D-TTE for the assessment of the aortic annulus diameter in a normal paediatric population. Because of an underestimation of the maximum diameter by 2D-TTE and the asymmetry of the aortic annulus, 3D measurements could be important before percutaneous aortic valvuloplasty or surgical replacement.
在儿童先天性主动脉瓣病变中，准确评估主动脉根部几何形状对于指导手术或血管造影干预是必要的。
比较二维和三维经胸超声心动图（2D-和 3D-TTE）测量的主动脉瓣环直径，以确定 3D 成像的可行性和可重复性，并评估心动周期中的动态变化。
前瞻性纳入 30 例无心脏病的儿童。使用多平面重建在舒张期和收缩期离线测量两个正交的主动脉瓣环直径，并与 2D-TTE 测量的主动脉瓣环直径进行比较。
平均年龄为 11±3.6 岁。3D 成像的可行性为 100%。观察者内和观察者间的变异系数分别为 3.5%和 6%。收缩期 2D 平均直径明显小于 3D 最大直径（1.94 与 2.01mm；p=0.005）。2D 和 3D 测量值相关性良好（p<0.0001）。3D 中的最大和最小直径在收缩期和舒张期均有显著差异（p<0.001），强调了主动脉瓣环的偏心性。在心动周期中，平均主动脉瓣环直径在收缩期和舒张期之间没有显著差异，但个体间存在重要的变异性。
本研究表明，3D-TTE 可用于评估正常儿科人群的主动脉瓣环直径，具有可行性和可重复性。由于 2D-TTE 对最大直径的低估和主动脉瓣环的不对称性，在经皮主动脉瓣成形术或外科置换术前，3D 测量可能很重要。
