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[GW-ICC]访谈:三维超声心动图前景广阔

作者:国际循环网   日期:2015/10/31 18:47:29

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编者按:20世纪80年代出现的三维超声成像技术立即受到众多学者的关注,并在技术上不断地发展完善,从静态三维超声成像发展到动态三维超声成像,后来又成为心脏立体图像。三维超声心脏图像对观察病变结构的形态、部位、大小及周邻关系等有重要意义。

  编者按:20世纪80年代出现的三维超声成像技术立即受到众多学者的关注,并在技术上不断地发展完善,从静态三维超声成像到动态三维超声成像,后来又发展为心脏立体图像。三维超声心脏图像对观察病变结构的形态、部位、大小及周边关系等有重要意义。前任美国超声心动图学会(ASE)主席、美国芝加哥大学Roberto Lang教授在接受采访时再次肯定了三维超声心动图的显著优势。

  International Circulation: Dr. Lang, it is a great honor to have you here. I would like to ask you some questions about echocardiography. The first one is: compare to the 2D echocardiography, what are the unique advantages does the 3D echocardiography have for evaluation of cardiac function? And what are the values can the 3D echocardiography bring to patient with cardiovascular disease?

  三维超声心动图优势

  Lang:Well, that is a very good question. I think 3D echo has distinct advantages over 2D echo, exactly what you are asking which is quantitation. There are two main advantages: when we quantify the left ventricular volume by using 2D echo, we many times underestimate the volumes. And the main reason for that is because we do foreshortening, instead of getting true apical foregen review, we obtained more foreshortening view. The other reason is we are always assuming the ventricle have certain geometry, in this case it is probably the “eclips”. with 3D echo, we can avoid this 2 problems, because we are trying a pyramid data we are not doing foreshortening, and also we can see any type of significant dilation we can account for it. So because of these advantages, 3D echo are more accurate, and it is more reproducible.

  与传统二维超声心动图相比,三维超声心动图具有独特优势。鉴于二维超声心动图主要通过透视评估,且评估时只能假定心室有特定的几何形状,而实际上并非如此,故二维超声心动图测定左心室容积时易低估。与之不同,采用三维超声心动图通过金字塔型数据集对心室容积进行评估,能发现任何形式的显著扩张并在计算心室容积时进行校正,结果更准确、可重复性更高。

  International Circulation:How do you evaluate the application prospect of 3D echo and the interventional treatment of cardiovascular disease?

  三维超声心动图应用前景

  Lang:Well, this is a very interesting question that you are asking. Because in reality, structural heart disease was developed at the same time with the 3D echo. Now we got to the situation, that without 3D echo, it will be very difficult to do sometimes of interventions. The most important intervention you can do with 3D echo are all of those taking into account the major valve. So if you are trying to closure the valve from leak, in 3D echo you can see there are two positions, and you can get very good view of that. On the other hand of positioning of micro valve clip, it is also impossible or very difficult to do without 3D echo. There are many other interventions, in which I think 3D echo will become extremely useful. As we today heard in the meeting, such as the positioning of the valve inside of the valve, or the valve inside of ring, or the use of prosthetic valves….I think for all these steps of situations, 3D echo is imperative to be used get with interventions for structural heart diseases.

  三维超声心电图对结构性心脏病介入治疗有非常重要的指导价值。目前,借助三维超声心动图主要针对心脏主要瓣膜开展治疗,如在针对瓣周漏进行封堵时,三维超声可从两个角度进行定位。此外,在缺乏三维心脏超声指导的情况下,二尖瓣夹合术的实施也非常有难度。此外,三维超声心动图对瓣中瓣定位及人工瓣膜应用也有重要指导意义。

  International Circulation:And also, with the increasing use 3D echo and accumulating in data, what impact do you think will bring to the guideline on quantitative analysis of ventricular and heart failure management?

  三维超声心动图对心室量化及心衰管理指南的潜在影响

  Lang:So I think those are really interesting questions. I have the pleasure of writing on behave of American Society of Echo and European Association of Cardiovascular Imaging the guidelines of chamber quantitation; and I think it is very interesting or important to note, that now for the first time of the guidelines, 3D echo, chamber quantitation of LV volumes, chamber quantitation of RV volumes have been recommended to be used. Because 3D echo is more accurate and is more producible, with these guidelines I have written again in 5 or 8 years, we will see in addition to the left ventricle, the right ventricle will also be guidelines on the use for the quantification of left atrial and also for quantification of LV mass. So this is very good time to start learning how to do 3D echo.

  鉴于三维超声心动图更准确、可重复性更高,ASE和欧洲心血管成像协会制定的心室量化指南首次推荐采用三维超声量化左心室及右室容积。因此,医生有必要开始学习三维超声心动图的临床操作和解读。

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