| Objective: We wanted to estimate the feasibility of observing pulmonary veinsand Coronary sinus structure by transthoracic real-time three-dimensionalechocardiography(RT-3DE), observe the change of pulmonary veins(PVs) andmitral flow(MIF) pattern besides pulmonary vein flow(PVF) pattern in the patientswith atrial fibrillation, compare the differences between three-dimensionalechocardiography and transesophageal echocardiography in detecting PV diametersand evaluate the potiential cilinical benifit of three-dimensional echocardiography inthe atrial fibrillation(AF) treatment.Methods:1. The pulmonary veins structure were observed in 161 patients by usingthree-dimensional echocardiography. The patients were divided to two groupsAFgroup (n=81)and sinus rhythm (SR) group (n=80).2. The echocardiography were applied in 126 patients,who were divided to SRgroup(n=64) and AF group(n=62), AF group were divided to two subgroups: theparoxysmal AF group and non paroxysmal AF group. The left atrial area(LAA), leftatrial volume(LAV), the diameter of left atrial(LAD), the end of the left ventriculardiastolic diameter (LVDD), ejection fraction(EF), mitral flow pattem(MIF)pulmonary vein flow pattern and aorta flow pattern were measured by using2-dimensional echocardiography.Measured the diameters of PVs by usingthree-dimensional echocardiography.3. The diameters of left superior pulmonary vein (LSPV) which were accqured bytransesophageal echocardiography were compared with which were obtained bythree-dimensional echocardiography.4. RT-3DE was performed in 104 patients to visualize coronary sinus structures inmultiple orientations and cross sections with static and dynamic fashions.Results:1. The feasibility of pulmonary veins and Coronary sinus structure by usingtransthoracic three-dimensional echocardiography. In 161 patients, there were 138patients(85.71%) whose four pulmonary veins could be distinguished clearly. 12patients (7.45%) couldn't demonstrate all of four PVs, 11 (6.83%) patients couldn't demonstrate PVs clearly. In SR group, numbers and ratios were 70 patients(87.5%), 5patients(6.25%)and 5patients (6.25%) respectively. In AF group, the respectivenumbers and ratios were 68 patients(83.95%), 7 patients(8.64%) and 6 patients(7.41%). There were no significant difference between two groups(x~2=0.447, p=0.800).2. Change of PVsand mitral flow(MIF) patternbesides pulmonary vein(PVF)flow pattern in the patients with atrial fibrillation by using transthoracicthree-dimensional echocardiography. Compared to the SR group, the diameters of fourPVs were remarkable increased in AF group and compared nonparoxysmal AFsubgroup with paroxysmal AF subgroup the diameters of four PVs were remarkableincreased, which the difference had statistics meanings(P＜0.05). The four PVs of SRparoxysmal AF and nonparoxysmal AF did not show statisticsdifference(P＞0.05). Measurement of two-dimensional echocardiography: in themeasurement of LA,LAA,LAV, the AF group's variables were highly increased whichhas signifflcent statistics difference compared to SR group. In the nonparoxysmal AFgroup these variables had much more augment compared to paroxysmal AF subgroup.two-dimensional pluse doppler measurement: the duration time of MIF had obviousreducing in AF group than in SR group (312.26±62.27 and548.77±69.21, p＜0.05), MV-VTI declining also can be observed in AFgroup(19.37±5.81 and 22.53±6.92, p＜0.05). The S wave part in PVF had a decliningtrend and the D wave part a ascending trend in AF and non paroxysmal AF subgroup.There were no significant difference in the comparation of D wave between nonparoxysmal AF and paroxysmal AF group. There were closely correlation betweenthe four PVs and LAD. (LSPVand LAD r=0.622, p=0.000; LIPV and LADr=0.715, p=0.000; RSPV and LAD r=0.725, p=0.000; RIPV and LAD r=0.663,p=0.000)3. Compared the difference of PV diameters between three-dimensionalechocardiography and transesophageal echocardiographyic. The mean measurementof LSPV in three-dimensional echocardiography and transesophagealechocardiography were 12.94±1.70mm and 12.86±2.01mm (p=0.895) respectively,The value of two groups were closely correlated (r=0.880 p＜0.01).4. Coronary sinus imaging: In 104 patients (SRgroup n=64, AF group n=40 ). There were 56 patients(87.5%) whose coronary sinus could be distinguished clearlyand 8 (12.5%) patients couldn't distinguished clearly in SR group. In AF group therewere 33 patients(82.50%) whose Coronary sinus could be distinguished clearlyand 7 (17.5%)patients couldn't distinguished clearly. The causes of couldn'tdistinguished clearly were the crosssection was not standard in 6 cases (40.0%), Thedepth wasn't adjusted properly in 4 cases (26.7%), there were 5 cases(33.3%)whomwhole heart couldn't involed in full volume imaging because of dilation of theheart.Conclusion:1. Transthoracic three-dimensional echocardiography can be a harmless methodto observe pulmnary veins. The heart rhythm in a certain range has no significantinfluence on three-dimensional echocardiography imaging.2. The pulmonary veins dilate significantly in patients with AF. The dilation extentdepend on the AF duration time and has a closed correlation with LAD.3. The shortened duration time of MIF in AF patients reflect the decrease of leftventricular filling time, which may be one of the possible causations of pulmonaryvein diliation.4. The S wave in PVF has a declining trend and the D wave has a ascending trendin AF. But there are no statistics differences, which might be due to the smaller sample.We should do more investigation with larger sample.5. By using three-dimensional echocardiography can observe the PV and CS frommulti- perspectives. There may be potential clinical application value in the AFtreatment and following-up, but further research is needed to confirm it. |
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