Amplatzer Septal Occluder Closure of Atrial Septal Defect: Evaluation of Transthoracic Echocardiography, Cardiac CT, and Transesophageal Echocardiography
Amplatzer Septal Occluder Closure of Atrial Septal Defect: Evaluation of Transthoracic Echocardiography, Cardiac CT, and Transesophageal Echocardiography
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DOI：
10.2214/ajr.09.2854
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发表时间：
2009-12-01
影响因子：
5
通讯作者：
Chen, Min-Chi
中科院分区：
文献类型：
--
作者：
Ko, Sheung-Fat;Liang, Chi-Di;Chen, Min-Chi
目标。本研究的目的是比较经胸超声心动图（TTE）、心脏CT和经食管超声心动图（TEE）对Amplatzer房间隔封堵器封堵儿童患者房间隔缺损（ASD）的评价。研究对象和方法。我们回顾了28例最初诊断为TTE的ASD患儿，他们在TEE指导下接受心脏CT检查以评估是否插入Amplatzer间隔闭塞器。将患者分为小ASD组（长轴< 1.5 cm）和大ASD组（长轴>= 1.5 cm）。比较TTE、心脏CT和TEE获得的ASD测量值。Kappa统计用于关联两位独立评论者评估的心脏CT诊断价值。经心脏CT检查，6例患者排除闭塞器植入；因此，22例患者（男孩7例，女孩15例，平均年龄4.95岁，范围2-11岁）被纳入研究。两组患者的年龄、性别差异无统计学意义，但大asd组肺/全身血流量比明显大于小asd组（3.54 +/- 1.43 vs 1.89 +/- 0.36; p = 0.001）。在ASD长、短轴长度、房间隔、四缘及缘缺检测方面，两组心室收缩末期心脏CT表现与TEE表现均无显著差异。大ASD组收缩期末及TEE时心脏CT测ASD长轴明显长于TTE时（p = 0.012）。较高的诊断评分和良好的观察者间相关性（kappa = 0.674-0.750）验证了心脏CT评估Amplatzer鼻中隔封堵器封堵ASD的可行性。大ASD的长轴在TTE中可能被低估。心脏CT在评估ASD方面与TEE相当，有助于Amplatzer间隔闭塞器植入的无创评估，特别是对于大ASD。
OBJECTIVE. The purpose of this study was to compare transthoracic echocardiography (TTE), cardiac CT, and transesophageal echocardiography (TEE) in the evaluation of secundum atrial septal defect (ASD) for closure with an Amplatzer septal occluder in pediatric patients.SUBJECTS AND METHODS. The cases of 28 children with ASD initially diagnosed with TTE who were scheduled for cardiac CT for evaluation for insertion of an Amplatzer septal occluder under TEE guidance were reviewed. The patients were divided into a group with small ASD (long axis < 1.5 cm) and a group with large ASD (long axis >= 1.5 cm). Measurements of the ASD obtained at TTE, cardiac CT, and TEE were compared. Kappa statistics were used to correlate the diagnostic value of cardiac CT assessed by two independent reviewers.RESULTS. After cardiac CT, six patients were excluded from occluder implantation; therefore, 22 patients (seven boys, 15 girls; mean age, 4.95 years; range, 2-11 years) were included in the study. There were no significant differences in the ages and sexes of the patients in the two groups, but pulmonary-to-systemic blood flow ratio in the large-ASD group was significantly greater than that in the small-ASD group (3.54 +/- 1.43 vs 1.89 +/- 0.36; p = 0.001). With respect to long-and short-axis lengths of the ASD, interatrial septum, and four rims and to detection of rim deficiency, neither group had a significant difference between cardiac CT findings at ventricular end-systole and TEE findings. The long axis of the ASD in the large-ASD group measured at cardiac CT at end-systole and TEE was significantly longer than the long axis measured at TTE (p = 0.012). A high diagnostic score with good interobserver correlation (kappa = 0.674-0.750) validated the feasibility of cardiac CT in the assessment of ASD for closure with an Amplatzer septal occluder.CONCLUSION. The long axis of a large ASD can be underestimated at TTE. Cardiac CT seems comparable with TEE in the assessment of ASD and is helpful in noninvasive evaluation for Amplatzer septal occluder implantation, especially for large ASD.