Hadeed Khaled, Hascoet Sébastien, Amadieu Romain, Karsenty Clément, Cuttone Fabio, Leobon Bertrand, Dulac Yves, Acar Philippe
Pediatric Cardiology Unit, Children Hospital, CHU, Toulouse, France.
Pediatric Cardiology Unit, Children Hospital, CHU, Toulouse, France; Inserm UMR1048, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, F-31000, France.
J Am Soc Echocardiogr. 2016 Aug;29(8):777-785. doi: 10.1016/j.echo.2016.04.012. Epub 2016 Jun 8.
Morphologic description of ventricular septal defect (VSD) is mandatory before performing the newly developed transcatheter closure procedure. Inaccurate estimation of defect size has been reported using conventional two-dimensional (2D) transthoracic echocardiography (TTE). The aim of this study was to assess VSD morphology and size using three-dimensional (3D) TTE compared with 2D TTE and surgery.
Forty-eight children aged 21.4 ± 29.3 months with isolated muscular (n = 11 [22.9%]) and membranous (n = 37 [77.1%]) VSDs were prospectively included. Three-dimensional images were acquired using full-volume single-beat mode. Minimal diameter, maximal diameter, and systolic and diastolic VSD areas were measured from 3D data sets using multiplanar reconstruction mode (QLAB 9). Maximal-to-minimal VSD diameter ratio was used to assess VSD geometry. Linear regression analysis and the Bland-Altman method were used to compare 3D measurements with 2D and surgical measurements in a subgroup of 15 patients who underwent surgical VSD closure.
VSD 3D diameters and areas were measured in all patients (100%; 95% CI, 92.6%-100%). Maximal diameter was lower on 2D TTE compared with 3D TTE (7.3 vs 11.3 mm, P < .0001). Mean bias was 4 mm, with 95% of values ranging from -1.76 to 9.75 mm. Correlation between 3D maximal diameter and surgical diameter was strong (r(2) = 0.97, P < .0001), while correlation between maximal 2D diameter and surgical diameter was moderate (r(2) = 0.63, P < .0001). VSDs had an oval shape when assessed by 3D TTE. Maximal-to-minimal diameter ratio assessed by 3D TTE was significantly higher in muscular VSDs compared with membranous VSDs (3.20 ± 1.51 vs 2.13 ± 1.28, respectively, P = .01). VSD area variation throughout the cardiac cycle was 32% and was higher in muscular compared with membranous VSDs (49% vs 26%, P = .0001).
Three-dimensional TTE allows better VSD morphologic and maximal diameter assessment compared with 2D TTE. VSD shape and its changes during the cardiac cycle can be visually and quantitatively displayed. Three-dimensional echocardiography may thus be particularly useful before and during percutaneous VSD closure.
在进行新开发的经导管封堵术之前，必须对室间隔缺损（VSD）进行形态学描述。据报道，使用传统的二维（2D）经胸超声心动图（TTE）对缺损大小的估计不准确。本研究的目的是使用三维（3D）TTE与2D TTE及手术结果相比较，评估VSD的形态和大小。
前瞻性纳入48例年龄为21.4±29.3个月的孤立性肌部（n = 11 [22.9%]）和膜部（n = 37 [77.1%]）VSD患儿。使用全容积单搏模式获取三维图像。使用多平面重建模式（QLAB 9）从三维数据集中测量最小直径、最大直径以及收缩期和舒张期VSD面积。使用最大与最小VSD直径比评估VSD几何形状。在15例行手术VSD封堵的患者亚组中，采用线性回归分析和Bland-Altman方法将三维测量结果与二维及手术测量结果进行比较。
所有患者（100%；95%CI，92.6% - 100%）均测量了VSD的三维直径和面积。与三维TTE相比，二维TTE测得的最大直径较低（7.3 vs 11.3 mm，P <.0001）。平均偏差为4 mm，95%的值范围为 - 1.76至9.75 mm。三维最大直径与手术直径之间的相关性很强（r² = 0.97，P <.0001），而二维最大直径与手术直径之间的相关性为中等（r² = 0.63，P <.0001）。通过三维TTE评估时，VSD呈椭圆形。三维TTE评估的肌部VSD最大与最小直径比显著高于膜部VSD（分别为3.20±1.51和2.13±1.28，P =.01）。整个心动周期中VSD面积变化为32%，肌部VSD的变化高于膜部VSD（49% vs 26%，P =.0001）。
与二维TTE相比，三维TTE能更好地评估VSD形态和最大直径。VSD形状及其在心动周期中的变化可进行直观和定量显示。因此，三维超声心动图在经皮VSD封堵术前和术中可能特别有用。
Zotero 插件