The Research Of The Clinical Application Of Real-Time Three-Dimensional Echocardiography In Pediatrics

To evaluate the diagnostic potential of Real-time Three-Dimensional Echocardiography (RT3DE) in Ventricular Septal Defects (VSD),102 patients with VSD were diagnosed by RT3DE and Two-Dimensional Echocardiography (2DE), and the results were compared with surgical findings. The defects were delineated objectively from many unique directions and angles by RT3DE that would not be available with 2DE, even simulated intraoperative visualization. The RT3DE views of VSD including the anatomical shape, positon, size and spatial relations could be appraised in their nature. The VSD maximum diameters obtained from RT3DE was 1.02±0.14 cm, from 2DE was 0.86±0.28 cm, from surgical findings was 1.05±0.36 cm. There was no statistical difference between measurements made by RT3DE and those obtained at surgery, there was a statistical difference between 2DE and RT3DE or surgical findings. Compared with the 2DE, RT3DE could display the true stereoscopic views of VSD, and provide better quantitative evaluation of the size, and lead to an improved understanding of the pathophysiology of VSD. RT3DE has important applied potentiality in clinical field. To investigate the clinical value of Real-time Three-Dimensional Echocardiography(RT3DE) in assessment of left ventricular regional systolic excursion and dyssynchrony in pediatrics, we studied 10 patients with dilated cardiomyopathy(DCM) and 22 patients with Kawasaki Disease(KD).55 normal children were studied as control group. Full-volume RT3DE was performed using Philips IE33 with the X7-2 matrix array 3D transducer. Post-processing software Qlab (version 5.1.2) was used for advanced analysis. The time to the point of minimal systolic volume (Tmsv) of LV in 16 segments were measured and its standard deviation (Tmsv16-SD) and maximal difference (Tmsvl6-Dif) were acquired automatically by RT3DE analysis. To allow comparisons between patients with significantly different heart rate, Tmsv 16-Dif and Tmsv16-SD were expressed as a percentage of the duration of the cardiac cycle (Tmsvl6-Dif%, Tmsv16-SD%). Simultaneously, RT3DE can automatically measured average excursion and average ball excursion of every segments of LV. In control group, Tmsvl6-Dif, Tmsvl6-SD, Tmsvl6-Dif%, Tmsvl6-SD% have no statistical difference in sex. Tmsv16-Dif and Tmsvl6-SD have statistical difference in age. Tmsvl6-Dif% and Tmsvl6-SD% have no statistical difference in age. Healthy subjects had highly synchronized segmental function (Tmsv16-Dif 28.04±15.50ms, Tmsv16-SD 7.44±3.43ms, Tmsv16-Dif% 4.70±2.04, Tmsvl6-SD% 1.24±0.47). All the indexes of systolic asynchrony were significantly larger in the DCM group (Tmsv16-Dif 164.40±78.28ms, Tmsvl6-SD 51.40±38.44ms, Tmsv16-Dif% 28.96±14.26, Tmsv16-SD% 9.51±6.22) and KD group (Tmsv16-Dif 89.55±30.53ms, Tmsvl6-SD 26.55±11.10ms, Tmsv16-Dif% 16.69±6.25, Tmsv16-SD% 4.93±2.27) than those of the control group. The RT3DE segmental time-volume curves of normal heart with normal synchronicity was shown with few dispersions and there was wide varation in the timing of regional minimal volume in the patients with DCM and KD. In control group, excursion and ball excursion have no statistical difference in sex. Excursion and ball excursion had statistical difference in age. The excursion of apical was smaller than that of mid and basal segments. The ball excursion of basal segments was larger than that of mid and apical segments. There was no statistical difference in excursion and ball excursion between ventricular septum and other segments. The ball excursion was significant smaller in the DCM group than that of the normal group. So we can come to the conclusion that Tmsv16-Dif% and Tmsvl6-SD% of RT3DE can quantify global left ventricular mechanical dyssynchrony. Ball excursion can assessment all the segments of left ventricle. RT3DE was proven a feasible and accurate method for analysis left ventricular function.