Isaaz K, Cloez J L, Danchin N, Marçon F, Worms A M, Pernot C
Am J Cardiol. 1985 Sep 15;56(8):539-45. doi: 10.1016/0002-9149(85)91181-6.
Evaluation of the right ventricular (RV) outflow tract in congenital heart disease is extremely important for surgical management. Therefore, the value of 2-dimensional echocardiography (2-D echo) to assess the RV outflow tract was studied using a new approach: the subcostal elongated right oblique view. Twenty normal children and 49 children with congenital heart disease, aged 1 day to 11 years, were studied. Significant pulmonary infundibular obstruction was present in 22 patients with conotruncal malformations. To obtain the subcostal elongated right oblique view from the short-axis view at the aortic valve level, the transducer was slightly rotated clockwise with an anterior angulation of about 30 degrees so that the ascending aorta was seen in its long axis, providing an image similar to that obtained by a right ventriculogram in the elongated right anterior oblique view. The deviation of infundibular septum was appreciated by measurement of the angle alpha, defined by the long axis of the infundibular septum and the plane of aortic cusps. This view could be obtained in 64 patients (92%). In correlation with angiographic or anatomic data, the subcostal elongated right oblique view permitted recognition of several types of RV outflow tract: type I--normally formed RV outflow tract; type II--disorganized RV outflow tract with obstruction (alpha less than 90 degrees); type III and IV--disorganized RV outflow tract with obstruction (alpha greater than 90 degrees). This view could visualize the crista supraventricularis in type I, but also the anatomic components of RV outflow tract that may contribute to obstruction in the other types: infundibular septum, septoparietal trabeculations and trabecula septomarginalis.(ABSTRACT TRUNCATED AT 250 WORDS)
评估先天性心脏病患者的右心室流出道对于手术治疗极为重要。因此，我们采用一种新方法——肋下延长右斜位视图，研究二维超声心动图（2-D echo）评估右心室流出道的价值。研究对象为20名正常儿童和49名年龄在1天至11岁之间的先天性心脏病患儿。22例圆锥干畸形患者存在明显的肺动脉漏斗部梗阻。为从主动脉瓣水平的短轴视图获取肋下延长右斜位视图，将探头顺时针轻微旋转约30度并向前成角，以便能看到升主动脉的长轴，从而获得与右心室造影在延长右前斜位视图中所获图像相似的图像。通过测量由漏斗间隔长轴与主动脉瓣叶平面所定义的α角，可了解漏斗间隔的偏移情况。64例患者（92%）可获得此视图。与血管造影或解剖学数据相关，肋下延长右斜位视图可识别几种类型的右心室流出道：I型——正常形态的右心室流出道；II型——伴有梗阻的紊乱右心室流出道（α小于90度）；III型和IV型——伴有梗阻的紊乱右心室流出道（α大于90度）。此视图在I型中可显示室上嵴，同时也能显示其他类型中可能导致梗阻的右心室流出道的解剖结构：漏斗间隔、隔顶小梁和隔缘肉柱。（摘要截断于250字）
