Acar P, Piéchaud J F, Bonhoeffer P, Aggoun Y, Bonnet D, Iserin L, Sidi D, Kachaner J
Service de cardiologie pédiatrique, hôpital Necker-Enfants Malades, Paris.
Arch Mal Coeur Vaiss. 1998 May;91(5):543-50.
The decision to close an ostium secundum atrial septal defect by interventional catheterisation implies knowing its size, form and the relationship of its borders to neighbouring structures as accurately as possible. Three-dimensional echocardiography provides unique views of the interatrial septum and the authors set out to assess its performance. Ten patients, aged 8 to 20 years, included in a multicenter European clinical trial of closure of atrial septal defects with the CardioSEAL prostheses, were examined by transoesophageal echocardiography with three-dimensional reconstruction of the interatrial septum viewed from the left or right atrium. The septal defect had a very variable morphology, round, oval raquet-shaped and occasionally multiple. The surface area of these defects varied by about 70% during the cardiac cycle, maximal during ventricular systole and minimal during atrial systole. The maximal diameter measured by two-dimensional transoesophageal echocardiography underestimated that measured by three-dimensional echocardiography by about 30%. Two patients had a juxta-aortic caudal border or a juxta-superior vena caval cephalic border making the defect unsuitable for catheter insertion of a CardioSEAL occluder. On the other hand, another patient had an adequate juxta-aortic border although it seemed too narrow with conventional imaging techniques. The authors conclude that three-dimensional reconstruction of transoesophageal echocardiography is the best method of selecting candidates for closure of ostium septum atrial septal defect by intervantional catheterisation.
通过介入导管术闭合继发孔型房间隔缺损的决定意味着要尽可能准确地了解其大小、形态以及其边界与邻近结构的关系。三维超声心动图能提供房间隔的独特视图，作者着手评估其性能。在一项使用CardioSEAL假体闭合房间隔缺损的欧洲多中心临床试验中，对10名年龄在8至20岁的患者进行了经食管超声心动图检查，并从左心房或右心房对房间隔进行三维重建。房间隔缺损的形态变化很大，呈圆形、椭圆形、球拍形，偶尔为多发。这些缺损的表面积在心动周期中变化约70%，在心室收缩期最大，在心房收缩期最小。二维经食管超声心动图测量的最大直径比三维超声心动图测量的约小30%。两名患者有近主动脉尾侧边界或近上腔静脉头侧边界，使得缺损不适合插入CardioSEAL封堵器进行导管操作。另一方面，另一名患者有足够的近主动脉边界，尽管用传统成像技术看起来太窄。作者得出结论，经食管超声心动图三维重建是选择通过介入导管术闭合房间隔继发孔缺损患者的最佳方法。
