这项工作由匈牙利政府研究基金[GINOP-2.3.2-15-2016-00043，Szív-és érkutatási kiválóságközpont（IRONHEART）]资助。

所有患者在检查前根据当地伦理委员会的批准（OGYÉI/12743/2018）签署了知情同意书。
1. 准备工作
<ol><li>从患者准备开始检查:确保至少4小时的禁食状态，关于吞咽问题和已知上消化道疾病的问卷调查。</li>
	<li>确保阅读并签署书面知情同意书。</li>
	<li>检查前准备静脉注射管路。</li>
	<li>将患者置于左外侧卧位。</li>
	<li>使用静脉注射咪达唑仑（2.5-5mg）给予轻度镇静剂。</li>
	<li>监测心电图和血氧饱和度。</li>
</ol>2. 图像采集
<ol><li>左侧 PV 的可视化<ol>
<li>将探针插入距门牙约30-40厘米的食道中。</li>
		<li>在上部（或中部）经食管探头位置，使用20-45°的2D图像采集可视化LAA。</li>
		<li>稍微顺时针转动探头，将晶体角度更改为60-80°，以便将LAA集中在图像上。</li>
		<li>单击全音量按钮以应用全体积 3D 采集。</li>
		<li>调整图像的横向和立面宽度以显示 LAA 和左上方 PV。这增强了左侧脊的可视化。</li>
		<li>优化图像质量（调整深度和增益，应用谐波成像）。</li>
		<li>记录一个具有2个心脏周期的单拍（如果可行，多拍）循环。</li>
		<li>将 2D 图像上的角度更改为大约 120°，以集中 LAA。</li>
		<li>稍微逆时针转动探头，并应用前屈以观察左侧PV的视距。</li>
		<li>应用彩色多普勒编码成像，以确认上下PV可见。</li>
		<li>单击全音量按钮以应用全体积 3D 采集。</li>
		<li>调整图像的横向和立面宽度以显示左侧 PV。这增强了左上下PV以及中间脊的视距的可视化。</li>
		<li>控制数据集质量。检查记录的数据集。如果数据集不包含上部和下部 PV，请通过进一步倾斜到横向位置来更改患者位置，然后重复步骤 2.1.8 中的步骤。</li>
		<li>从左侧PV获取3D全体积数据集:具有2个心脏周期的单拍（如果可行，多拍）循环。</li>
		<li>通过将图像分别裁剪到上部或下部 PV 孔来确认 PV 视孔的可见性。下部 PV 口需要特别仔细的确认。由于解剖学原因，例如角度或靠近换能器，骨的某些部分不在3D数据集中，这并非不合时宜。</li>
		<li>如果图像不适合可视化完整的PV结构，请重复步骤2.1.10中的步骤。如有必要，更改 3D 数据集的横向或高程宽度。</li>
	</ol>
</li>
	<li>正确 PV 的可视化<ol>
<li>切换回 2D 模式，将图像聚焦到食管探头上方（或中部）45° 处的 LAA。</li>
		<li>顺时针转动探头并将探头移动到前屈位置，以便可视化正确的PV。</li>
		<li>应用彩色多普勒编码成像，以确认上下PV可见。</li>
		<li>单击全音量按钮以应用全体积 3D 采集。</li>
		<li>调整图像的横向和立面宽度以显示正确的 PV。这增强了右上下PV以及中间脊的视距的可视化。此图像可用于识别是否存在多余的PV。</li>
		<li>从正确的PV获取3D全体积数据集:一拍（如果可行，多拍）循环，具有2个心脏周期。</li>
		<li>通过将图像分别裁剪到上部或下部 PV 孔来确认 PV 视孔的可见性。下部 PV 口需要特别仔细的确认。由于解剖学原因（例如，角度或靠近换能器），3D数据集的某些部分在3D数据集之外并不罕见。</li>
		<li>如果数据集不包含上部和下部PV，则应通过进一步向正确位置倾斜来改变患者位置，并且应从步骤2.2.1开始重复该过程。如有必要，更改 3D 数据集的横向或高程宽度。</li>
	</ol>
</li>
</ol>3.3D 图像重建和测量
<ol><li>离线3D多平面重建<ol>
<li>激活扫描仪或工作站上的 3D 分析软件（飞利浦:在 QApps 面板中激活 3DQ 软件;Tomtec:激活4D有氧视图3应用程序;GE:激活FlexiSlice软件）。</li>
		<li>选择舒张期的框架进行测量。为了标准化，建议选择一个定时到T波的帧。</li>
		<li>将两个垂直平面设置为请求的结构（左侧脊或每个PV孔）并调整平面方向，而第三 个平面表示所检查结构的 en面 视图。</li>
		<li>在左侧面板上，选择测量选项。 en 面部 视图适用于测量（直径、面积、距离）。</li>
	</ol>
</li>
</ol>

<ol>
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A., Ho, S. Y., Climent, V., Sanchez-Quintana, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+architecture+of+the+left+lateral+atrial+wall:+a+particular+anatomic+region+with+implications+for+ablation+of+atrial+fibrillation.">The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation.</a> European Heart Journal. 29 (3), 356-362 (2008).</li><li>Kubala, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+pulmonary+veins+anatomy+is+associated+with+better+AF-free+survival+after+cryoablation+as+compared+to+atypical+anatomy+with+common+left+pulmonary+vein.">Normal pulmonary veins anatomy is associated with better AF-free survival after cryoablation as compared to atypical anatomy with common left pulmonary vein.</a> Pacing and Clinical Electrophysiology. 34 (7), 837-843 (2011).</li><li>Guler, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Pulmonary+Vein+Anatomy+and+Pulmonary+Vein+Diameters+on+Outcome+of+Cryoballoon+Catheter+Ablation+for+Atrial+Fibrillation.">Effect of Pulmonary Vein Anatomy and Pulmonary Vein Diameters on Outcome of Cryoballoon Catheter Ablation for Atrial Fibrillation.</a> Pacing and Clinical Electrophysiology. 38 (8), 989-996 (2015).</li><li>Baran, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+pulmonary+vein+ostia+anatomy+on+efficacy+of+cryoballoon+ablation+for+atrial+fibrillation.">Impact of pulmonary vein ostia anatomy on efficacy of cryoballoon ablation for atrial fibrillation.</a> Heart Beat Journal. 1, 65-70 (2017).</li><li>Sorgente, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+vein+ostium+shape+and+orientation+as+possible+predictors+of+occlusion+in+patients+with+drug-refractory+paroxysmal+atrial+fibrillation+undergoing+cryoballoon+ablation.">Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation.</a> Europace. 13 (2), 205-212 (2011).</li><li>Chun, K. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+'single+big+cryoballoon'+technique+for+acute+pulmonary+vein+isolation+in+patients+with+paroxysmal+atrial+fibrillation:+a+prospective+observational+single+centre+study.">The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study.</a> European Heart Journal. 30 (6), 699-709 (2009).</li><li>Cabrera, J. 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J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+vein+isolation:+the+impact+of+pulmonary+venous+anatomy+on+long-term+outcome+of+catheter+ablation+for+paroxysmal+atrial+fibrillation.">Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation.</a> Heart Rhythm. 11 (4), 549-556 (2014).</li><li>Mansour, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+anatomy+of+the+left+atrium+by+magnetic+resonance+angiography:+implications+for+catheter+ablation+for+atrial+fibrillation.">Three-dimensional anatomy of the left atrium by magnetic resonance angiography: implications for catheter ablation for atrial fibrillation.</a> Journal of Cardiovascular Electrophysiology. 17 (7), 719-723 (2006).</li><li>Ottaviano, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryoballoon+ablation+for+atrial+fibrillation+guided+by+real-time+three-dimensional+transoesophageal+echocardiography:+a+feasibility+study.">Cryoballoon ablation for atrial fibrillation guided by real-time three-dimensional transoesophageal echocardiography: a feasibility study.</a> Europace. 15 (7), 944-950 (2013).</li><li>Faletra, F. 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作者报告没有利益冲突。

在这里，我们展示了一种分步方法，通过3D超声心动图研究PV，其周围结构和解剖学特征。上述用于PV的3D成像方法是一种易于标准化的方法，它为大多数患者提供了适合精确测量的高质量3D图像。所采集图像的最佳质量和方向对于PV解剖结构的适当评估至关重要。3D重建图像增强了PV引流模式的可视化及其解剖变异性，这可能会影响PVI与CA的成功率。
PV的3D成像克服了传统2D经食?...

肺静脉 （PV） 的引流模式变化很大，平均人群变异率为 56.5%1。在规划 PV 隔离 （PVI） 时，评估 PV 引流模式至关重要，这是目前最常见的心房颤动介入治疗2，3，4。虽然射频导管消融术一直是实现PVI的标准技术，但基于冷冻球囊（CB）的消融技术（CA）是一种需要较少手术时间的替代方法。与射频消融相比，该技术不那么复杂5，6，而CA的功效和安全性与射频消融相似7。
CB的程序性PV闭塞率和PV口组织损伤的连续环向延伸决定了CA后PVI的永久成功。PV闭塞的主要决定因素之一是PV解剖结构的变化。在最近的基于计算机断层扫描（CT）和心脏MRI的研究中，确定了几个PV参数，并具有CA后短期和长期成功率的预测值。这些参数包括PV解剖结构（左侧普通PV，多余的PV8，9，10，骨面积，椭圆度指数8，11，12，13）及其周围环境（中间脊8，14，15，16，左侧脊的厚度8，9，17）的变化。
虽然传统的2D超声心动图不适合显示和测量上述大部分参数，但三维经食管超声心动图（3D TEE）似乎是可视化PV的替代工具，如先前的文献数据所示18，19。
此外，与CT或MRI相比，PVI之前的3D TEE具有额外的价值，因为它不仅为程序设计提供了PV特性的数据，而且还澄清了左心耳（LAA）中是否存在血栓。在PVI之前，这项调查尤其重要。同时，3D TEE需要的时间更少，其程序成本低，并且不会使患者和医务人员暴露于辐射。
过去，存在几种类型的不同大小的CB，这使得很难推断PV的各种参数如何影响CA的成功率。今天，新推出的第二代CB用于CA，CA仅以一种尺寸存在。由于其改进的冷却效果，与第一代CB20相比，第二代CB提供了更高的性能，这进一步凸显了PV解剖学和PVI之前介入计划的重要性。

<table><tbody><tr><td>4D Cardio-view 3 software</td><td>Tomtec Imaging Systems GmbH</td><td></td><td></td></tr><tr><td>Epiq 7G scanner</td><td>Philips</td><td></td><td></td></tr><tr><td>Q-Lab Software</td><td>Philips</td><td></td><td></td></tr><tr><td>X5-1 transducer</td><td>Philips</td><td></td><td></td></tr><tr><td>Vivid E95 Scanner</td><td>GE</td><td></td><td></td></tr><tr><td>4Vc-D transducer</td><td>GE</td><td></td><td></td></tr></tbody></table>

three-dimensional echocardiographic method for the visualization and assessment of specific parameters of the pulmonary veins

在计划肺静脉分离 （PVI） 时，肺静脉的尺寸是重要参数，尤其是使用冷冻球囊消融技术时。承认肺静脉（PVs）的尺寸和解剖学变化可能会改善干预的结果。常规的2D经食管超声心动图只能提供有关PV尺寸的有限数据;然而，3D超声心动图可以进一步评估PV的相关直径和区域，以及它们与周围结构的空间关系。在以往的文献数据中，已经确定了影响PVI成功率的参数。这些是左侧脊，中间脊，PV的骨面积和骨的椭圆指数。通过3D超声心动图对PV进行适当的成像是一种技术上具有挑战性的方法。一个关键步骤是收集图像。需要三个单独的传感器位置来可视化重要结构;这些是左侧脊，PV的骨脊以及左右PV的中间脊。接下来，采集3D图像并将其保存为数字循环。这些数据集将被裁剪，这将导致 en 人脸视图显示空间关系。该步骤也可用于确定PV的解剖学变化。最后，创建多平面重建以测量PV的每个单独参数。
所采集图像的最佳质量和方向对于PV解剖结构的适当评估至关重要。在目前的工作中，我们检查了PV的3D可见性以及上述方法在80名患者的适用性。目的是提供光伏可视化和评估3D超声心动图的基本步骤和潜在陷阱的详细概述。

使用上述图像采集方案，第一步是使用2D采集可视化左心耳（LAA）（图1）。探头位于经食管上部（或中部）20-45°。该图显示了 LAA。左侧脊和左上侧PV以60-80°显示（图2），然后通过裁剪数据集获取并确认3D数据集，以便可视化LAA和左上部PV口的左侧脊（图3）。如果数据集不包含LAA和左侧脊的整个结构，则在改变探针角度，屈曲或?...

Watch this Scientific Journal Video about Three-Dimensional Echocardiographic Method for the Visualization and Assessment of Specific Parameters of the Pulmonary Veins at JoVE.com

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

肺静脉 （PV） 的尺寸是计划肺静脉分离时的重要参数。2D经食管超声心动图只能提供有关PV的有限数据;然而，3D超声心动图可以评估PV的相关直径和区域，以及它们与周围结构的空间关系。

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 ...

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JoVE Journal

Bioengineering

2.7K 次观看.  University of Debrecen. 肺静脉 （PV） 的尺寸是计划肺静脉分离时的重要参数。2D经食管超声心动图只能提供有关PV的有限数据;然而，3D超声心动图可以评估PV的相关直径和区域，以及它们与周围结构的空间关系。

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

Transthoracic Echocardiography in Mice

In recent years, murine models have become the primary avenue for studying the molecular mechanisms of cardiac dysfunction resulting from changes in gene expression. Transgenic and gene targeting methods can be used to generate mice with altered cardiac size and function,1-3 and as a result, in vivo techniques are needed to evaluate their cardiac phenotype. Transthoracic echocardiography, pulse wave Doppler (PWD), and tissue Doppler imaging (TDI) can be used to provide dimensional measurements of the mouse heart and to quantify the degree of cardiac systolic and diastolic performance. Two-dimensional imaging is used to detect abnormal anatomy or movements of the left ventricle, whereas M-mode echo is used for quantification of cardiac dimensions and contractility.4,5 In addition, PWD is used to quantify localized velocity of turbulent flow,6 whereas TDI is used to measure the velocity of myocardial motion.7 Thus, transthoracic echocardiography offers a comprehensive method for the noninvasive evaluation of cardiac function in mice.

Transthoracic echocardiography offers a noninvasive method for the evaluation of cardiac function in mice. A combination of ultrasound and Doppler imaging modalities can be used to obtain dimensional measurements of the heart and intracardiac blood flow, which together provide an assessment of cardiac systolic and diastolic performance.

经胸超声心动图在小鼠

In recent years, murine models have become the primary avenue for studying the molecular mechanisms of cardiac dysfunction resulting from changes in gene ...

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

Transthoracic Echocardiographic Examination in the Rabbit Model

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to that of humans and that of other large animal models such as dogs and pigs. However, the rabbit model has the additional advantage of lower maintenance costs compared to other large animal models. The longitudinal evaluation of cardiac function using echocardiography, when appropriately implemented, is a useful methodology for preclinical assessment of novel therapies for heart failure with reduced ejection fraction (e.g. cardiac regeneration). The correct use of this non-invasive tool requires the implementation of a standardized examination protocol following international guidelines. Here we describe, step by step, a detailed protocol supervised by veterinary cardiologists for performing echocardiography in the rabbit model, and demonstrate how to correctly obtain the different echocardiographic views and imaging planes, as well as the different imaging modes available in a clinical echocardiography system routinely used in human and veterinary patients.

Here we describe, step by step, a detailed protocol for performing echocardiography in the rabbit model. We show how to correctly obtain the different echocardiographic views and imaging planes, as well as the different imaging modes available in a clinical echocardiography system routinely used in human and veterinary patients.

兔子模型中的跨胸超声心动图检查

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to ...

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

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 ventricular (RV) function has strong diagnostic and prognostic power in various cardiovascular disorders. Due to its complex morphology and function, assessment of the RV by conventional two-dimensional echocardiography is limited: the everyday clinical practice usually relies on simple linear dimensions and functional measures. Three-dimensional (3D) echocardiography overcame these limitations by providing volumetric quantification of the RV free of geometrical assumptions. Here, we offer a step-by-step guide to obtain and analyze 3D echocardiographic data of the RV using the leading commercially available software. We will quantify 3D RV volumes and ejection fraction. Several technical aspects may help to improve the quality of RV acquisition and analysis as well, which we present in a practical manner. We review the current opportunities and the limiting factors of this method and also highlight the potential applications of 3D RV assessment in current clinical practice.

Here, we provide a step-by-step acquisition and analysis protocol for the 3D volumetric assessment of the right ventricle, mainly focusing on the practical aspects that maximize the feasibility of this technique.

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 ...

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 ...

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement

The measurements of the right ventricle (RV) and pulmonary artery (PA), for selecting the optimal prosthesis size for transcatheter pulmonary valve replacement (TPVR), vary considerably. Three-dimensional (3D) computed tomography (CT) imaging for device size prediction is insufficient to assess the displacement of the right ventricular outflow tract (RVOT) and PA, which could increase the risk of stent misplacement and paravalvular leak. The aim of this study is to provide a dynamic model to visualize and quantify the anatomy of the RVOT to PA over the entire cardiac cycle by four-dimensional (4D) cardiac CT reconstruction to obtain an accurate quantitative evaluation of the required valve size. In this pilot study, cardiac CT from sheep J was chosen to illustrate the procedures. 3D cardiac CT was imported into 3D reconstruction software to build a 4D sequence which was divided into eleven frames over the cardiac cycle to visualize the deformation of the heart. Diameter, cross-sectional area, and circumference of five imaging planes at the main PA, sinotubular junction, sinus, basal plane of the pulmonary valve (BPV), and RVOT were measured at each frame in 4D straightened models prior to valve implantation to predict the valve size. Meanwhile, dynamic changes in the RV volume were also measured to evaluate right ventricular ejection fraction (RVEF). 3D measurements at the end of the diastole were obtained for comparison with the 4D measurements. In sheep J, 4D CT measurements from the straightened model resulted in the same choice of valve size for TPVR (30 mm) as 3D measurements. The RVEF of sheep J from pre-CT was 62.1 %. In contrast with 3D CT, the straightened 4D reconstruction model not only enabled accurate prediction for valve size selection for TPVR but also provided an ideal virtual reality, thus presenting a promising method for TPVR and the innovation of TPVR devices.

This study assessed a new methodology with a straightened model generated from the four-dimensional cardiac computed tomography sequence to obtain the desired measurements for valve sizing in the application of transcatheter pulmonary valve replacement.

用于经导管肺动脉瓣置换术的四维计算机断层扫描引导的瓣膜尺寸

The measurements of the right ventricle (RV) and pulmonary artery (PA), for selecting the optimal prosthesis size for transcatheter pulmonary valve ...

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography

Targeted neonatal echocardiography (TnECHO) refers to the use of comprehensive echocardiographic evaluation and physiologic data to obtain accurate, reliable, and real-time information on developmental hemodynamics in sick newborns. The comprehensive assessment is based on a multiparametric approach that overcomes the reliability issues of individual measurements, allows for earlier recognition of cardiovascular compromise and promotes enhanced diagnostic precision and timely management. TnECHO-driven research has led to an enhanced understanding of the mechanisms of illness and the development of predictive models to identify at-risk populations. This information may then be used to formulate a diagnostic impression and provide individualized guidance for the selection of cardiovascular therapies. TnECHO is based on the expert consultative model in which a neonatologist, with advanced training in neonatal hemodynamics, performs comprehensive and standardized TnECHO assessments. The distinction from point of care ultrasonography (POCUS), which provides limited and brief one-time assessments, is important. Neonatal hemodynamics training is a 1-year structured program designed to optimize image acquisition, measurement analysis, and hemodynamic knowledge (physiology, pharmacotherapy) to support cardiovascular decision-making. Neonatologists with hemodynamic expertise are trained to recognize deviations from normal anatomy and appropriately refer cases of possible structural abnormalities. We provide an outline of neonatal hemodynamics training, the standardized TnECHO imaging protocol, and an example of representative echo findings in a hemodynamically significant patent ductus arteriosus.

Presented here is a protocol to perform comprehensive neonatal echocardiography by trained neonatologists in the neonatal intensive care unit. The trained individuals provide longitudinal assessments of heart function, systemic and pulmonary hemodynamics in a consultative role. The manuscript also describes the requirements to become a fully trained neonatal hemodynamics specialist.

使用靶向新生儿超声心动图在新生儿重症监护病房中测定血流动力学精度

Targeted neonatal echocardiography (TnECHO) refers to the use of comprehensive echocardiographic evaluation and physiologic data to obtain accurate, ...

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 ...