项目编号NVKP_16-1-2016-0017（"国家心脏计划"）已在匈牙利国家研究，发展和创新基金的支持下实施，该基金由NVKP_16资助计划资助。该研究由匈牙利创新与技术部的主题卓越计划（2020-4.1.1.-TKP2020）在塞梅尔威斯大学的治疗开发和生物成像主题计划的框架内资助。

该方案遵循该机构人类研究伦理委员会的指导方针，临床病例的患者对该研究给予书面知情同意。
1. 技术要求
<ol><li>对于 3D 采集和分析，请使用适当的软件和硬件。使用超声心动图设备的心电电缆;此外，对于下面描述的完整3D采集协议，这是强制性的。</li>
	<li>对于 3D 采集，请使用 3D 超声心动图探头和兼容 3D 的超声机。对于 3D RV 体积分析，请使用专用软件。</li>
</ol>2. 收购
<ol><li>在绝大多数情况下，使用顶点视图对 RV 进行 3D 采集。与以左心室为中心的观点相反，建议采用不同的患者体位。如果通过在正确的顶点视图上切换到一个肋间空间可以实现更好的图像质量，则这种透视缩短的视图可以实现更好的3D图像质量。透视收缩可以在 3D 分析过程中进行校正。<ol><li>与建议使用左侧卧位（患者躺在左侧，左臂伸展在头部上方）的标准根尖超声心动图采集相比，患者稍微向后倾斜，以使换能器的位置更侧。</li>
		<li>选择仅包含 RV 的图像深度。 不必要的大深度可能会降低采集帧速率，同时对 RV 体积分析缺乏有益的影响。</li>
	</ol></li>
	<li>从 2D 超声心动图图像中确认正确的右心室聚焦视图。如果即使从这个角度看，RV的自由壁也很难看到，那么预期的3D图像质量将无法成为进一步分析的最佳选择。</li>
	<li>使用 4D 按钮切换到实时 3D 成像，可以对 RV 视图进行进一步校正。</li>
	<li>虽然 3D 实时 模式在美学上可能非常令人愉悦，但对 3D 视图使用 12 Slice 模式，该模式显示感兴趣区域的三平面图像以及可以自由修改的 9 个横截面平面。通过旋转和正确定位切割平面，确认整个 RV 自由壁（包括流出道和顶端段）的可见性。</li>
	<li>通过使用扇区的左倾（触摸屏上的第二页）进一步调整图像，以改善 RV 可视化。</li>
	<li>使用两种 3D 采集模式进行 RV 体积分析: 多拍 和 单拍 模式。在每位患者中使用这两种方法，但在某些情况下（例如，某些心律失常，患者的严重呼吸困难），只有后一种方法可能是可行的。</li>
	<li>使用 单拍 模式，在图像质量和帧速率之间实现权衡。选择最佳图像深度、宽度和帧速率（触摸屏的下面板），无需任何进一步操作即可获得 RV 的 3D 循环。这种方法在大多数患者中是可行的;但是，与 多拍 方法相比，它产生的图像质量和帧速率通常较低。<ol><li>在平均（60-70/分钟）心率的情况下，保持 16 帧/秒的帧速率下限，以便进行充分的 RV 分析;但是，如果存在心动过速，则建议使用更高的帧速率。</li>
	</ol></li>
	<li>使用 多拍 模式，从可在触摸屏上选择的给定数量的心跳周期重建获取的 3D 循环（可以使用 2、3、4 和 6 拍模式）。与单拍采集相比，通常期望更好的图像质量和帧速率;然而，由于强制性屏气动作，它需要相对恒定的心动周期长度以及患者的依从性。该操作对于避免所谓的拼接伪影至关重要:当将获取的3D体积缝合在一起时，不相等的心动周期长度和/或由于呼吸引起的运动可能会导致这种现象。<ol><li>正确定位探头并设置机器后（类似于"单拍"模式），要求患者深呼吸并屏住呼吸。在这种情况下，扩张的肺通常覆盖整个图像。</li>
		<li>要求患者在指导下缓慢呼气。在肺部放气的同时，RV 再次变得可见。</li>
		<li>当整个RV（游离壁和隔膜）再次出现时，要求患者在这种状态下屏住呼吸。</li>
		<li>通过在屏幕上单击 多拍 ，开始采集，3D循环在给定的心动周期内建立。</li>
		<li>当采集准备就绪（整个房车可视化）时，要求患者再次自由呼吸。</li>
		<li>检查获得的循环以确保没有拼接或丢失伪影。</li>
	</ol></li>
</ol>3. 4D 房车分析
<ol><li>使用专用软件对RV进行3D体积分析。从患者库中选择以 RV 为中心的 3D 循环后，从"卷"文件夹中的"测量"窗口中打开软件。</li>
	<li>打开软件后，将 RV 定向到四个预定义的切割平面上。<ol><li>将两个标记（电视中心）放在左上和左下长轴平面的三尖瓣中心。使用旋转工具将图像的长轴调整为 RV 的实际长轴。右上角的参考图像显示了正确方向的显示方式。</li>
		<li>在右上和右下面板上，通过旋转将短轴图像对齐到正确的位置。与上一步类似，参考图像也有助于此过程。</li>
	</ol></li>
	<li>完成后，单击 设置地标 以执行下一步分析。在两个图像中设置地标。<ol><li>在左侧，在自由壁（电视自由壁）和隔膜（电视隔）处标记三尖瓣环，并在先前定向的顶端四室视图上标记 RV 顶点。</li>
		<li>在右侧，设置右心室后部（左心室/右心室后部）和前插入点（左心室/右心室前部）和右心室游离壁（右心室游离壁）。与上一个窗口类似，右上角的参考图像有助于正确设置。设置所有地标后，软件会自动跳转到下一个窗口（查看）。</li>
	</ol></li>
	<li>在此窗口（查看）中，如有必要，查看并手动纠正整个心动周期中的自动心内膜边界检测。默认情况下，可以看到 9 个面板:左侧是 3 个移动环（1 个长轴和 2 个短轴），中间是相同图像的舒张末期帧，右侧是收缩末期帧。<ol><li>在错误跟踪的情况下，通过单击它们自由纠正心内膜边界（绿线），跟踪边界。使用短轴上的旋转工具，查看沿 RV 整个圆周跟踪的图像。 通过选择右侧面板上的笔大小来调整校正幅度。如果认为跟踪正确，请单击同一面板中的结果。</li>
	</ol></li>
	<li>在最后一部分中，查看右上角的最终 3D 体积数据和其他计算参数（"工作表 "面板）。除了 RV 体积和射出分数外，该软件还显示 2D 参数，例如线性（中轴、基轴和长轴）直径，以及从预定义的顶端四腔室视图得出的 FAC 和 TAPSE 值。该软件还显示了RV的长轴和短轴（左侧），RV的3D实时模型（中上）和腔室的体积-时间曲线（右下）。<ol><li>如果需要进一步调整跟踪，可以通过单击右侧面板上的每个先前步骤进行更正。如果跟踪和 3D 参数被视为有效，请单击同一面板上的"批准并退出"来保存结果。</li>
	</ol></li>
</ol>

<ol>
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RV 的 3D 分析是日常心脏病学实践中的重要一步。随着人们对以前被忽视的心腔的形态和功能的兴趣日益浓厚，这些新颖的解决方案提供了有关心脏右侧的临床有意义的信息。虽然3D采集有几个方面与2D超声心动图成像明显不同，但通过特别注意关键点并使用全面的协议，3D RV分析可以从科学工具发展成为超声心动图检查的重要步骤。凭借最佳的图像质量和适当的专业知识，使用超声心动图进行RV体?...

超声心动图从 1950 年代的首次临床应用开始了漫长的道路1.第一个一维超声探头旨在提供腔室壁和腔的简单线性直径;然而，它们无疑代表了心血管成像的一个里程碑。二维（2D）超声成像的发展是另一个重要步骤，它提供了更精确的形态和功能量化，并且仍然被认为是日常临床实践中的标准方法。然而，基于2D超声心动图的评估仍然存在该技术的主要局限性:从几个断层扫描平面对给定腔室的成像不能充分表征三维（3D）结构的形态和功能。这个问题在右心室 （RV） 的情况下更为明显:与相对简单的子弹形左心室 （LV） 相比，右心室具有复杂的几何形状2 ，无法使用线性直径或区域3 充分量化。尽管有这些广为人知的事实，但RV的形态和功能通常在临床实践中通过这些简单的参数来测量。
几十年来，与左翼对应物相比，RV 被认为在流通中的作用要小得多。几篇具有里程碑意义的论文推翻了这一观点，表明RV几何形状和功能在多种疾病中的强烈预后作用4，5，6，7。大量研究表明，即使使用相对简单的常规参数，RV测量的增量价值也突出了对具有潜在有意义的临床价值的腔室进行更精确定量的重要性和需求。
3D超声心动图克服了心腔2D评估的几个局限性。虽然在LV的情况下，没有几何假设的体积和功能参数的测量也可能引起高度关注，但在RV8的评估中可能变得特别重要。3D 衍生的右心室体积和射血分数 （EF） 在各种心血管疾病中具有显着的预后价值9，10。
如今，一些供应商提供用于 3D RV 评估的半自动解决方案，并根据金标准心脏磁共振 （MR） 测量结果验证结果11，12。3D评估的技术要求是当今最先进的心血管成像部门的重要组成部分，预计它很快就会成为每个超声心动图实验室通用设备的一部分。凭借在3D采集和后处理方面的适当专业知识，3D RV分析可以很容易地实施到标准检查方案中。

<table><tbody><tr><td>3V-D/4V-D/4Vc-D</td><td>General Electric</td><td>n.a.</td><td>ultrasound probe</td></tr><tr><td>4D Auto RVQ</td><td>General Electric</td><td>n.a.</td><td>software for analysis</td></tr><tr><td>E9/E95</td><td>General Electric</td><td>n.a.</td><td>ultrasound machine</td></tr><tr><td>EchoPac v203</td><td>General Electric</td><td>n.a.</td><td>software for analysis</td></tr></tbody></table>

morphological and functional assessment of the right ventricle using 3d echocardiography

传统上，人们认为心脏的右侧在循环中起着次要的作用;然而，越来越多的数据表明，右心室（RV）功能对各种心血管疾病具有很强的诊断和预后能力。由于其复杂的形态和功能，通过传统的二维超声心动图评估RV是有限的:日常临床实践通常依赖于简单的线性尺寸和功能测量。三维 （3D） 超声心动图克服了这些限制，提供了不受几何假设影响的 RV 体积定量。在这里，我们提供了一个分步指南，使用领先的商用软件获取和分析RV的3D超声心动图数据。我们将量化 3D RV 体积和射出分数。几个技术方面也可能有助于提高RV采集和分析的质量，我们以实用的方式介绍。我们回顾了该方法的当前机会和限制因素，并强调了3D RV评估在当前临床实践中的潜在应用。

RV 的 3D 分析在各种心血管疾病中是可行的。病例1是一名健康的志愿者，心室容量和功能正常（图1）。病例 2 是一名二尖瓣修复术后患者，他是传统 2D 评估结果相互矛盾的典型示例:虽然 TAPSE 明显降低，但患者未表现出任何右心室功能障碍的迹象，并且 3D RV EF 正常证实右心室整体收缩功能维持（图 2）。两位患者都有出色的超?...

Watch this Scientific Journal Video about Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography at JoVE.com

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography

在这里，我们为右心室的3D体积评估提供了一步一步的采集和分析方案，主要侧重于最大化该技术可行性的实际方面。

使用3D超声心动图对右心室进行形态学和功能评估

Traditionally, it was believed that the right side of the heart has a minor role in circulation; however, more and more data suggest that right ...

morphological-functional-assessment-right-ventricle-using-3d

Research

JoVE Journal

Medicine

2.8K 次观看.  Semmelweis University Heart and Vascular Center. 在这里，我们为右心室的3D体积评估提供了一步一步的采集和分析方案，主要侧重于最大化该技术可行性的实际方面。

视频: Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography

Echocardiographic Assessment of the Right Heart in Mice

Transgenic and toxic models of pulmonary arterial hypertension (PAH) are widely used to study the pathophysiology of PAH and to investigate potential therapies. Given the expense and time involved in creating animal models of disease, it is critical that researchers have tools to accurately assess phenotypic expression of disease. Right ventricular dysfunction is the major manifestation of pulmonary hypertension. Echocardiography is the mainstay of the noninvasive assessment of right ventricular function in rodent models and has the advantage of clear translation to humans in whom the same tool is used. Published echocardiography protocols in murine models of PAH are lacking.
In this article, we describe a protocol for assessing RV and pulmonary vascular function in a mouse model of PAH with a dominant negative BMPRII mutation; however, this protocol is applicable to any diseases affecting the pulmonary vasculature or right heart. We provide a detailed description of animal preparation, image acquisition and hemodynamic calculation of stroke volume, cardiac output and an estimate of pulmonary artery pressure.

This article provides a protocol for the echocardiographic assessment of right ventricular size and pulmonary hypertension in mice. Applications include phenotype determination and serial assessment in transgenic and toxin-induced mouse models of cardiomyopathy and pulmonary vascular disease.

右心小鼠的超声心动图评价

Transgenic and toxic models of pulmonary arterial hypertension (PAH) are widely used to study the pathophysiology of PAH and to investigate potential ...

科研

医学

Assessment of Right Ventricular Structure and Function in Mouse Model of Pulmonary Artery Constriction by Transthoracic Echocardiography

Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure1-3. Moreover, the RV is significantly affected in pulmonary diseases such as pulmonary artery hypertension (PAH). In addition, the RV is remarkably sensitive to cardiac pathologies, including left ventricular (LV) dysfunction, valvular disease or RV infarction4. To understand the role of RV in the pathogenesis of cardiac diseases, a reliable and noninvasive method to access the RV structurally and functionally is essential.
A noninvasive trans-thoracic echocardiography (TTE) based methodology was established and validated for monitoring dynamic changes in RV structure and function in adult mice. To impose RV stress, we employed a surgical model of pulmonary artery constriction (PAC) and measured the RV response over a 7-day period using a high-frequency ultrasound microimaging system. Sham operated mice were used as controls. Images were acquired in lightly anesthetized mice at baseline (before surgery), day 0 (immediately post-surgery), day 3, and day 7 (post-surgery). Data was analyzed offline using software.
Several acoustic windows (B, M, and Color Doppler modes), which can be consistently obtained in mice, allowed for reliable and reproducible measurement of RV structure (including RV wall thickness, end-diastolic&#160;and end-systolic dimensions), and function (fractional area change, fractional shortening, PA peak velocity, and peak pressure gradient) in normal mice and following PAC.
Using this method, the pressure-gradient resulting from PAC was accurately measured in real-time using Color Doppler mode and was comparable to direct pressure measurements performed with a Millar high-fidelity microtip catheter. Taken together, these data demonstrate that RV measurements obtained from various complimentary views using echocardiography are reliable, reproducible and can provide insights regarding RV structure and function. This method will enable a better understanding of the role of RV cardiac dysfunction.

Right ventricle (RV) dysfunction is critical to the pathogenesis of cardiovascular disease, yet limited methodologies are available for its evaluation. Recent advances in ultrasound imaging provide a noninvasive and accurate option for longitudinal RV study. Herein, we detail a step-by-step echocardiographic method using a murine model of RV pressure overload.

右心室结构和功能的肺动脉缩窄经胸超声小鼠模型的评估

Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure1-3. Moreover, ...

Echocardiographic Approaches and Protocols for Comprehensive Phenotypic Characterization of Valvular Heart Disease in Mice

The aim of this manuscript and accompanying video is to provide an overview of the methods and approaches used for imaging heart valve function in rodents, with detailed descriptions of the appropriate methods for anesthesia, the echocardiographic windows used, the imaging planes and probe orientations for image acquisition, the methods for data analysis, and the limitations of emerging technologies for the evaluation of cardiac and valvular function. Importantly, we also highlight several future areas of research in cardiac and heart valve imaging that may be leveraged to gain insights into the pathogenesis of valve disease in preclinical animal models. We propose that using a systematic approach to evaluating cardiac and heart valve function in mice can result in more robust and reproducible data, as well as facilitate the discovery of previously underappreciated phenotypes in genetically-altered and/or physiologically-stressed mice.

This protocol provides a detailed description of the echocardiographic approach for comprehensive phenotyping of heart and heart valve function in mice.

超声心动图方法和协议心脏瓣膜疾病的综合表型特征小鼠

The aim of this manuscript and accompanying video is to provide an overview of the methods and approaches used for imaging heart valve function in ...

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Three-dimensional (3D) quantification of the left ventricle (LV) provides significant added value in terms of diagnostic accuracy and precise risk stratification in various cardiac disorders. Recently, 3D echocardiography became available in routine cardiology practice; however, high-quality image acquisition and subsequent analysis have a steep learning curve. The present article aims to guide the reader through a detailed 3D protocol by presenting tips and tricks and also by highlighting the potential pitfalls to facilitate the widespread but technically sound use of this important technique concerning the LV. First and foremost, we show the acquisition of a high-quality 3D dataset with optimal spatial and temporal resolution. Then, we present the analytical steps toward a detailed quantification of the LV by using one of the most widely applied built-in software. We will quantify LV volumes, sphericity, mass and also systolic function by measuring ejection fraction and myocardial deformation (longitudinal and circumferential strain). We will discuss and provide clinical examples about the essential scenarios where the transition from a conventional echocardiographic approach to a 3D-based quantification is highly recommended.

In this article, we provide a step-by-step acquisition and analysis protocol for the volumetric assessment and speckle-tracking analysis of the left ventricle by 3D echocardiography, particularly focusing on practical aspects that maximize the feasibility of this technique.

使用3D超声心动图评估左心室结构和功能

Three-dimensional (3D) quantification of the left ventricle (LV) provides significant added value in terms of diagnostic accuracy and precise risk ...

生物工程

Three-Dimensional Echocardiographic Method for the Visualization and Assessment of Specific Parameters of the Pulmonary Veins

The dimensions of the pulmonary veins are important parameters when planning pulmonary vein isolation (PVI), especially with the cryoballoon ablation technique. Acknowledging the dimensions and anatomical variations of the pulmonary veins (PVs) may improve the outcome of the intervention. Conventional 2D transoesophageal echocardiography can only provide limited data about the dimensions of the PVs; however, 3D echocardiography can further evaluate relevant diameters and areas of the PVs, as well as their spatial relationship to surrounding structures. In previous literature data, parameters influencing the success rate of PVI have already been identified. These are the left lateral ridge, the intervenous ridge, the ostial area of the PVs and the ovality index of the ostium. Proper imaging of the PVs by 3D echocardiography is a technically challenging method. One crucial step is the collection of images. Three individual transducer positions are necessary to visualize the important structures; these are the left lateral ridge, the ostium of the PVs and the intervenous ridge of the left and right PVs. Next, 3D images are acquired and saved as digital loops. These datasets are cropped, which result in the en face views displaying spatial relationships. This step can also be employed to determine the anatomical variations of the PVs. Finally, multiplanar reconstructions are created to measure each individual parameter of the PVs.
Optimal quality and orientation of the acquired images are paramount for the appropriate assessment of PV anatomy. In the present work, we examined the 3D visibility of the PVs and the suitability of the above method in 80 patients. The aim was to provide a detailed outline of the essential steps and potential pitfalls of PV visualization and assessment with 3D echocardiography.

The dimensions of the pulmonary veins (PV) are important parameters when planning pulmonary vein isolation. 2D transoesophageal echocardiography can only provide limited data about the PVs; however, 3D echocardiography can evaluate relevant diameters and areas of the PVs, as well as their spatial relationship to surrounding structures.

用于肺静脉特定参数可视化和评估的三维超声心动图方法

The dimensions of the pulmonary veins are important parameters when planning pulmonary vein isolation (PVI), especially with the cryoballoon ablation ...

Echocardiographic Measurement of Right Ventricular Diastolic Parameters in Mouse

Diastolic dysfunction is a prominent feature of right ventricular (RV) remodeling associated with conditions of pressure overload. However, the RV diastolic function is rarely quantified in experimental studies. This might be due to technical difficulties in the visualization of the RV in the apical four-chamber view in rodents. Here we describe two positions facilitating the visualization of the apical four-chamber view in mice to assess the RV diastolic function.
The apical four-chamber view is enabled by tilting the mouse fixation platform to the left and caudally (LeCa) or to the right and cranially (RiCr). Both positions provide images of comparable quality. The results of the RV diastolic function obtained from two positions are not significantly different. Both positions are comparably easy to perform. This protocol can be incorporated into published protocols and enables detailed investigations of the RV function.

Here we describe and compare two positions for obtaining the apical four-chamber view in mice. These positions enable the quantification of the right ventricular function, provide comparable results, and can be used interchangeably.

小鼠右心室舒张参数的超声心电图测量

Diastolic dysfunction is a prominent feature of right ventricular (RV) remodeling associated with conditions of pressure overload. However, the RV ...

Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats

The use of experimental animal models has become crucial in cardiovascular science. Most studies using rodent models are focused on two-dimensional imaging to study the cardiac anatomy of the left ventricle and M-mode echo to assess its dimensions. However, this could limit a comprehensive study. Herein, we describe a protocol that allows an assessment of the heart chamber size, left ventricular function (systolic and diastolic) and valvular function. A conventional medical ultrasound machine was used in this protocol and different echo views were obtained through left parasternal, apical and suprasternal windows. In the left parasternal window, the long and short axis were acquired to analyze left chamber dimensions, right ventricle and pulmonary artery dimensions, and mitral, pulmonary and aortic valve function. The apical window allows the measurement of heart chamber dimensions and evaluation of systolic and diastolic parameters. It also allows Doppler assessment with detection and quantification of heart valve disturbances (regurgitation or stenosis). Different segments and walls of the left ventricle are visualized throughout all views. Finally, the ascending aorta, aortic arch, and descending aorta can be imaged through the suprasternal window. A combination of ultrasound imaging, Doppler flow and tissue Doppler assessment have been obtained to study cardiac morphology and function. This represents an important contribution to improve the assessment of cardiac function in adult rats with impact for research using these animal models.

A non-invasive protocol for transthoracic echocardiography assessment of cardiac anatomy and function for adult rats is presented in the current study. The heart valves, all four cardiac chambers and the ascending aorta, aortic arch and descending aorta are studied in detail.

成人大鼠心脏解剖与功能的超声心动图评估

The use of experimental animal models has become crucial in cardiovascular science. Most studies using rodent models are focused on two-dimensional ...

Biventricular Assessment of Cardiac Function and Pressure-Volume Loops by Closed-Chest Catheterization in Mice

Assessment of cardiac function is essential to conduct cardiovascular and pulmonary-vascular preclinical research. Pressure-volume loops (PV loops) generated by recording both pressure and volume during cardiac catheterization are vital when assessing both systolic and diastolic cardiac function. Left and right heart function are closely related, reflected in ventricular interdependence. Thus, recording biventricular function in the same animal is important to get a complete assessment of cardiac function. In this protocol, a closed chest approach to cardiac catheterization consistent with the way catheterization is performed in patients is adopted in mice. While challenging, the closed chest strategy is a more physiological approach, because opening the chest results in major changes in preload and afterload that create artifacts, most notably a fall in systemic blood pressure. While high-resolution echocardiography is used to assess rodents, cardiac catheterization is invaluable, particularly when assessing diastolic pressures in both ventricles.
Described here is a procedure to perform invasive, closed chest, sequential left and right ventricular pressure-volume (PV) loops in the same animal. PV loops are acquired using&#160;admittance technology with a mouse pressure-volume catheter and pressure-volume system acquisition. The procedure is described, beginning with the neck dissection, which is required to access the right jugular vein and the right carotid artery, to the insertion and positioning of the catheter, and finally the data acquisition. Then, the criteria required to ensure the acquisition of high-quality PV loops are discussed. Finally, the analysis of the left and right ventricular PV loops and the different hemodynamic parameters available to quantify systolic and diastolic ventricular function are briefly described.

Presented here is a protocol to assess biventricular heart function in mice by generating pressure-volume (PV) loops from the right and left ventricle in the same animal using closed chest catheterization. The focus is on the technical aspect of surgery and data acquisition.

小鼠闭胸导管插入术对心功能和压力-容积环的双心室评估

Assessment of cardiac function is essential to conduct cardiovascular and pulmonary-vascular preclinical research. Pressure-volume loops (PV loops) ...

The Use of 3D Echocardiography in Surgical Planning of the Mitral Valve in Pediatric Cardiology

Mitral valve disease in pediatric cardiology is complex and can involve a combination of annular, leaflet, chordae tendineae and papillary muscle abnormalities. Transthoracic two-dimensional echocardiography (2DE) remains the primary diagnostic imaging technique utilized in pediatric surgical planning. However, given that the mitral valve is a three-dimensional (3D) structure, the addition of 3D echocardiography (3DE) to better define the mechanisms of stenosis and/or regurgitation is advantageous. Transthoracic 3DE technology has improved with advances in probe technology and ultrasound scanners, producing images with good spatial resolution and adequate temporal resolution. Specifically, the addition of pediatric 3D transducers with higher frequencies and a smaller footprint provides better 3DE imaging in children. Improved efficiency of 3DE acquisition and analysis allow 3D assessment of the mitral valve to be more easily integrated by the sonographer, the cardiologist and the surgeon in mitral valve assessment. This improvement was also made possible by the postprocessing software optimization.
In this method paper, we aim to describe the transthoracic 3DE assessment of the mitral valve in children and its use in the surgical planning of pediatric mitral valve disease. Firstly, the 3DE assessment begins by selecting the correct probe and by obtaining a view of the mitral valve. Then, the appropriate data acquisition method should be selected based on the individual patient. Next, optimization of the data set is critical in order to properly balance spatial and temporal resolution. During live scanning or following acquisition, the data set can be cropped using innovative tools that allow the user to quickly obtain an infinite number of cut planes or volumetric reconstructions. The cardiologist and surgeon can view the mitral valve en face; thus, accurately reconstructing its morphology in order to support medical or surgical planning. Finally, a review of some clinical applications is proposed, showing examples in pediatric mitral valve managements.

3D echocardiography of the mitral valve in pediatric cardiology produces full anatomic reconstructions that contribute to improved surgical management. Here, we outline a protocol for 3D acquisition and post-processing of the mitral valve in pediatric cardiology.

Mitral valve disease in pediatric cardiology is complex and can involve a combination of annular, leaflet, chordae tendineae and papillary muscle ...

基于 ICE 的左心房和肺静脉 3D 重塑

Three-Dimensional Modeling of the Left Atrium and Pulmonary Veins with a Precise Intracardiac Echocardiography Approach

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left atrium (LA) anatomy and pulmonary vein structures. ICE is widely used to establish a three-dimensional (3D) left atrial structural model during ablation procedures. However, it is unclear whether using ICE in a precise 3D modeling method can provide a more accurate left atrial 3D model and the transseptal approach. This study proposes a protocol to model the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter remodeling. It evaluates the accuracy of the models produced using the two methods through observer scoring. We included 50 patients who underwent ICE-based 3D remodeling and 45 who underwent FAM 3D remodeling based on pulmonary vein isolation procedures. The pulmonary vein antrum remodeling is estimated by comparing the antrum area acquired by remodeling and left atrial computed tomography angiography (CTA). The observer scores for the modeling in the ICE and FAM groups were 3.40 &#177; 0.81 and 3.02 &#177; 0.72 (P &#60; 0.05), respectively. The pulmonary vein antrum area obtained using the ICE- and FAM-based methods showed a correlation with the area acquired by left atrium CT. However, the 95% confidence interval bias was narrower in ICE-acquired models than in FAM-acquired models (-238 cm2 to 323 cm2 Vs. -363 cm2 to 386 cm2, respectively) using Bland-Altman analysis. Therefore, precise ICE possesses high accuracy in estimating the left atrial structure, becoming a promising approach for future cardiac structure estimation.

作者聚焦:用于心房解剖评估的心内超声心动图的进展 

Accurate intracardiac echocardiography (ICE) shows significant accuracy in estimating the left atrial structure, a prospective and promising cardiac structure estimation method. Here we propose a protocol for three-dimensional modeling of the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter remodeling.

使用精确的心内超声心动图方法对左心房和肺静脉进行三维建模

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left ...