Devarakonda Sarath Babu, Mannuva Boochi Babu, Durgaprasad Rajasekhar, Velam Vanajakshamma, Akula Vidya Sagar, Kasala Latheef
Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
J Cardiovasc Thorac Res. 2015;7(3):87-95. doi: 10.15171/jcvtr.2015.20.
Percutaneous transvenous mitral commissurotomy (PTMC) is a safe and effective procedure for relief of severe mitral stenosis. PTMC is being done widely and many transseptal procedures requiring large diameter catheters, sheaths are becoming popular. The knowledge of iatrogenic atrial septal defect (iASD) is vital. This study assessed the use of real-time 3D echocardiography (RT3DE) and incidence of iASD in a cohort of patients undergoing transseptal catheterization during PTMC.
One hundred ten patients underwent PTMC. The reliability and accuracy of RT3DE for iASD detection was determined, RT3DE was compared with 2D echocardiography (2DE) for iASD occurrence, influencing variables analyzed and followed up for 1 year.
RT3DE is more reliable and accurate for the study of iASD than 2DE. Color RT3DE detected iASD in 94 (85.5%), with 2DE iASD was detected in 74 (67.3%) (P < .0001).On follow up 85% had iASD post procedure, 56% at 6 months, 19% at 1 year follow up. The mean iASD diameter was 5.41 ± 3.12 mm and area 6.57 ± 3.81 mm(2). iASD correlated with patient height, Wilkins score, pre-PTMC LA 'v', and post-PTMC LVEDP.
RT3DE imaging is superior in accuracy to traditional 2DE techniques. All the modes of RT3DE are useful in the assessment of iASD. iASD measured by RT3DE correlates with several patient, procedural and echocardiographic variables.
经皮经静脉二尖瓣交界切开术（PTMC）是缓解重度二尖瓣狭窄的一种安全有效的手术。PTMC正在广泛开展，许多需要大直径导管、鞘管的经房间隔手术也越来越普遍。了解医源性房间隔缺损（iASD）至关重要。本研究评估了实时三维超声心动图（RT3DE）在PTMC期间经房间隔导管插入术患者队列中的应用及iASD的发生率。
110例患者接受了PTMC。确定了RT3DE检测iASD的可靠性和准确性，将RT3DE与二维超声心动图（2DE）在iASD发生情况方面进行比较，分析影响变量并随访1年。
RT3DE在研究iASD方面比2DE更可靠、准确。彩色RT3DE检测到94例（85.5%）iASD，2DE检测到74例（67.3%）（P <.0001）。随访时85%的患者术后存在iASD，6个月时为56%，1年随访时为19%。iASD的平均直径为5.41±3.12 mm，面积为6.57±3.81 mm²。iASD与患者身高、威尔金斯评分、PTMC前左心房“v”波以及PTMC后左心室舒张末期压力相关。
RT3DE成像在准确性上优于传统的2DE技术。RT3DE的所有模式在评估iASD方面都很有用。通过RT3DE测量的iASD与多个患者、手术和超声心动图变量相关。
