Imaging Atrial Septal Defects by Real-Time Three-Dimensional Transesophageal Echocardiography: Step-by-Step Approach
Imaging Atrial Septal Defects by Real-Time Three-Dimensional Transesophageal Echocardiography: Step-by-Step Approach
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DOI：
10.1016/j.echo.2010.08.008
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发表时间：
2010-11-01
影响因子：
6.5
通讯作者：
Kronzon, Itzhak
中科院分区：
文献类型：
--
作者：
Saric, Muhamed;Perk, Gila;Kronzon, Itzhak
背景资料：目前还没有标准化的房间隔和房间隔缺损（ASD）的三维（3D）经食管超声心动图（TEE）视图。如果没有一个标准化的方法，很难确定重要的解剖关系（例如ASD的主动脉边缘的位置），以执行相关测量（例如ASD的尺寸或其边缘的尺寸），或在房间隔闭合期间引导导管和装置的部署。使用3D TEE矩阵阵列换能器，在14个月的时间内进行了706项TEE研究。本研究的目的是制定一个标准化的协议，解剖正确的方向的三维TEE图像的房间隔和ASDs.Results：在706 TEE研究，有23例ASD，占研究人群的3.3%。18例继发性ASD，2例原发性ASD，3例上级腔静脉型静脉窦ASD。制定了正确定向房间隔和ASD的3D TEE图像的方案。当以0度角度采集图像时，通过向上倾斜然后向左倾斜的动作正确地定向隔膜。初始3D TEE图像首先向上倾斜以显示隔膜的右心房侧。然后将图像绕其垂直轴倾斜180度，以显示隔膜的左心房侧;主动脉边缘在左侧，上级腔静脉在顶部，右侧肺静脉口在屏幕右侧。对于更高角度的采集，使用z轴向左旋转操作。图像首先向上倾斜，以显示右心房的隔膜，如在向上倾斜然后向左倾斜的动作中。然后图像沿z轴逆时针旋转，直到上级腔静脉位于12点钟位置。最后，将图像绕垂直轴倾斜180度，以显示左房间隔。结论：使用标准化的z轴向上倾斜然后向左倾斜和向左旋转操作增强了ASD的诊断，保持了ASD与周围结构的重要解剖关系，并且便于获得3D TEE图像的超声心动图医师与进行ASD闭合的介入心脏病专家或心脏外科医生之间的通信。（J Am Soc Echocardiogr 2010; 23：1128-35.）
Background: There are currently no standardized three-dimensional (3D) transesophageal echocardiographic (TEE) views of the interatrial septum and atrial septal defects (ASDs). Without a standardized approach, it is difficult to ascertain the important anatomic relationships (such as the location of the aortic rim of an ASD), to perform relevant measurements (such as the size of an ASD or the size of its rims), or to guide the deployment of catheters and devices during atrial septal closure.Methods: Using a 3D TEE matrix-array transducer, 706 TEE studies were performed over a 14-month period. The purpose of the study was to develop a standardized protocol for anatomically correct orientation of 3D TEE images of the interatrial septum and ASDs.Results: Among 706 TEE studies, there were 23 patients with ASDs, representing 3.3% of the study population. Eighteen patients had secundum ASDs, two had primum ASDs, and three had sinus venosus ASDs of the superior vena cava type. A protocol for properly orienting 3D TEE images of the interatrial septum and ASDs was developed. When the images are acquired at an angle of 0 degrees, the septum is properly oriented by the tilt-up-then-left maneuver. The initial 3D TEE image in first tilted up to reveal the right atrial side of the septum. Then the image is tilted 180 degrees around its vertical axis to reveal the left atrial side of the septum; the aortic rim is on the left, the superior vena cava on the top, and the right-sided pulmonary vein ostia on the right side of the screen. For acquisitions at a higher angle, the rotate-left-in-z-axis maneuver is used. The image is first tilted up to reveal the right atrial side of the septum, as in the tilt-up-then-left maneuver. The image is then rotated counterclockwise in the z axis until the superior vena cave is at 12 o'clock. Finally, the image is tilted 180 degrees around its vertical axis to reveal the left atrial side of the septum.Conclusions: The use of standardized tilt-up-then-left and rotate-left-in-z-axis maneuvers enhances the diagnosis of ASDs, ascertains the important anatomic relationships of ASDs to surrounding structures, and facilitates communication between echocardiographers obtaining 3D TEE images and interventional cardiologists or cardiac surgeons performing ASD closures. (J Am Soc Echocardiogr 2010; 23: 1128-35.)