我们感谢强生约翰诺森律师事务所的顾问闫俊明，他负责研究资助。这项工作由吉林省科学技术厅（20220402076GH）资助。

该研究程序严格遵守吉林大学中日协和医院人体研究伦理委员会的规定。在Carto系统（3D映射系统）上搜索接受心房颤动射频消融的患者。然后，使用PACS系统确定患者在手术前是否进行了左心房CT检查，以确定每个选定的患者是否进行了左心房CT图像进行比较。Soundstar 是本研究中使用的 ICE 导管，3D 映射系统中提供了 Cartosound 模块。每位患者在 ICE 3D 建模前都提供了书面知情同意书。
1. 扫描前的准备
<ol><li>检查患者信息，例如准确的心率、节律、血压和血氧饱和度。让患者仰卧，双臂在两侧，大腿略微外展。</li>
	<li>在整个手术过程中，为所有患者提供芬太尼 （200 μg/mL） 的深度清醒镇静。选择右侧股静脉作为穿刺点，用2%利多卡因消毒并铺路进行局部麻醉。</li>
	<li>设置 ICE 导管:将 ICE 导管尾线与 3D 映射系统和超声波机器连接。在 3D 映射系统中打开"研究"界面，然后在"连接的机器"中选择"P500"。</li>
	<li>将ICE导管（直径:10f;超声模式:B模式）置于股静脉内。在推压过程中，实时监测超声波，确保导管处于安全空间。</li>
	<li>将消融导管传递到右心房，以形成右心房和冠状窦模型。将冠状动脉窦电极与 ICE 引导相结合放置冠状窦电极。</li>
	<li>ICE导管进入右心房后，确保左心房和左心耳结构在3D映射系统显示屏上显示左心房和左心耳结构，同时排除左心房血栓。</li>
	<li>插入房间隔穿刺针后，在ICE引导下确定最佳穿刺部位。然后，进行经鼻中隔穿刺。<ol><li>使用 "主页 "视图确认 ICE 已到达右心房。然后软件显示左侧 PV 部分。单击 右弯 以显示下腔静脉和房间隔。</li>
		<li>将穿刺针鞘移至指向四点钟方向。在监测 ICE 的同时将针鞘缩回椭圆形窝，可以看到"帐篷征"。</li>
		<li>调整 ICE 导管以显示左侧 PV 为"兔耳征"。在ICE引导下，将针鞘慢慢撤回到椭圆形窝的下缘。</li>
		<li>顺时针旋转穿刺针以突破椭圆形窝。然后，通过房间隔穿刺针注射肝素生理盐水。 注意:在 LA 中观察到盐水泡，表明房间隔成功穿刺。</li>
	</ol></li>
</ol>左心房和肺静脉的2. 3D建模
注:ICE在两个方向上构建左心房模型。
<ol><li>将ICE导管推入股静脉后，穿过下腔静脉和上腔静脉，进入右心房。</li>
	<li>将超声导管推到短轴右心房中间，顺时针旋转。现在，超声波风扇指向描绘右心房和右心室的一点钟方向（家庭视图）。</li>
	<li>拧紧张力 旋钮以实现锁定张力 调整。然后转到 "主页 "视图并单击 前曲率 （A） 以完全显示三尖瓣环。附着在三尖瓣环上进行门控训练，并使用呼吸末期建模。</li>
	<li>从 主页 视图，顺时针转向左心房前壁，导致左心耳的出现。</li>
	<li>继续顺时针转动至左心房，导致左上肺静脉和下肺静脉的出现，显示为"兔耳征"。然后，顺时针和逆时针转动它，通过识别前金静脉和后金静脉边界来精确收集左肺静脉的图像。</li>
	<li>继续顺时针转动左心房，建立后壁，在此过程中，食管出现"双轨征"。</li>
	<li>顺时针方向转向左心房，观察右下肺静脉，显示为"3字征"。然后，顺时针和逆时针转动它，通过识别前后边界来精确捕获右肺静脉的图像。</li>
	<li>在长轴上，单击 Palintrope（P） 使导管的尖端与冠状窦口的高度相同。这是对左心房模型的补充。调整左弯/ 右弯 （L/R） 以观察左心房长轴的前壁。该图像捕获了左心房的前壁。</li>
	<li>相应地标记重要的解剖位置，包括肺静脉口、左心耳和其他重要部位（视频 1）。</li>
</ol>3.肺静脉区域的图像采集和测量
<ol><li>左心房CT<ol><li>双击图标打开 PACS 系统 。单击 "高级查询 "以输入患者姓名和检查项目。单击 "确定 "以查找图像。</li>
		<li>点击 Tune 将图片传输到 vue pacs 系统（图片存档和通信系统）。</li>
		<li>将 3D 体积重建图像传输到工作箱，然后单击导出图像以将左心房后前 （PA）、左后 （LL） 和右外侧 （RL） 位置 图像 保存在文件夹中。</li>
		<li>返回上一个程序后，将左心房动脉期增强序列转移到工作框中，然后单击显示为 3D 的图像。</li>
		<li>双击 3D 图像，然后单击工具栏中的 3D 。选择切除 工具切除 肋骨、脊柱、主动脉和其他结构，以暴露左心房和肺静脉系统。</li>
		<li>暴露肺静脉前庭。单击工具栏中的" 图 "，然后选择 "面积 "以计算肺静脉前庭的横截面积。</li>
	</ol></li>
	<li>冰<ol><li>打开 3D 映射系统。然后，单击 "查看研究 "并输入患者姓名。最后，使用 "搜索当前患者 "来识别图像。</li>
		<li>单击 "确定 "打开工作界面。</li>
		<li>单击 "研究">"继续研究 "，然后选择 "模型 "和 "通道 "序列。</li>
		<li>单击" 捕获首选项"，然后选择" 区域 "并将图像调整为"后前"、"左外侧"、"右外侧"、"左前斜肌 （LAO）"和"右前斜肌 （RAO）"。</li>
		<li>单击"图片"，选择照片区域，然后单击"确定"以保存图片。</li>
		<li>单击 " 地图"选项，然后选择 "保存地图"。然后，使用工具栏中的 橡皮擦 去除左右肺静脉。</li>
		<li>单击图像，选择面积测量并测量肺静脉前庭的 面积 。</li>
	</ol></li>
</ol>

基于 ICE 的左心房和肺静脉 3D 重塑

<ol>
	<li>Xu, Y., Sharma, D., Li, G., Liu, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atrial+remodeling:+new+pathophysiological+mechanism+of+atrial+fibrillation.">Atrial remodeling: new pathophysiological mechanism of atrial fibrillation.</a> Medical Hypotheses. 80 (1), 53-56 (2013).</li><li>George, J. C., Varghese, V., Mogtader, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracardiac+echocardiography:+evolving+use+in+interventional+cardiology.">Intracardiac echocardiography: evolving use in interventional cardiology.</a> Journal of Ultrasound in Medicine. 33 (3), 387-395 (2014).</li><li>Jingquan, Z., 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=Intracardiac+echocardiography+Chinese+expert+consensus.">Intracardiac echocardiography Chinese expert consensus.</a> Frontiers in Cardiovascular Medicine. 9, 1012731 (2022).</li><li>Anter, 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=Comparison+of+intracardiac+echocardiography+and+transesophageal+echocardiography+for+imaging+of+the+right+and+left+atrial+appendages.">Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages.</a> Heart Rhythm. 11 (11), 1890-1897 (2014).</li><li>Rossillo, 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=Novel+ICE-guided+registration+strategy+for+integration+of+electroanatomical+mapping+with+three-dimensional+CT/MR+images+to+guide+catheter+ablation+of+atrial+fibrillation.">Novel ICE-guided registration strategy for integration of electroanatomical mapping with three-dimensional CT/MR images to guide catheter ablation of atrial fibrillation.</a> Journal of Cardiovascular Electrophysiology. 20 (4), 374-378 (2009).</li><li>Okumura, Y., 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+ultrasound+for+image-guided+mapping+and+intervention:+methods,+quantitative+validation,+and+clinical+feasibility+of+a+novel+multimodality+image+mapping+system.">Three-dimensional ultrasound for image-guided mapping and intervention: methods, quantitative validation, and clinical feasibility of a novel multimodality image mapping system.</a> Circulation: Arrhythmia and Electrophysiology. 1 (2), 110-119 (2008).</li><li>Liu, C. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+evolving+utility+of+intracardiac+echocardiography+in+cardiac+procedures.">The evolving utility of intracardiac echocardiography in cardiac procedures.</a> Journal of Atrial Fibrillation. 6 (6), 1055 (2014).</li><li>Bartel, T., Edris, A., Velik-Salchner, C., M&#252;ller, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracardiac+echocardiography+for+guidance+of+transcatheter+aortic+valve+implantation+under+monitored+sedation:+a+solution+to+a+dilemma.">Intracardiac echocardiography for guidance of transcatheter aortic valve implantation under monitored sedation: a solution to a dilemma.</a> European Heart Journal. Cardiovascular Imaging. 17 (1), 1-8 (2016).</li><li>Haissaguerre, 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=Spontaneous+initiation+of+atrial+fibrillation+by+ectopic+beats+originating+in+the+pulmonary+veins.">Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.</a> New England Journal of Medicine. 339 (10), 659-666 (1998).</li><li>Kaseno, K., 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+impact+of+the+CartoSound&#174;+image+directly+acquired+from+the+left+atrium+for+integration+in+atrial+fibrillation+ablation.">The impact of the CartoSound&#174; image directly acquired from the left atrium for integration in atrial fibrillation ablation.</a> Journal of Interventional Cardiac Electrophysiology. 53, 301-308 (2018).</li><li>Enriquez, 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=Use+of+intracardiac+echocardiography+in+interventional+cardiology:+working+with+the+anatomy+rather+than+fighting+it.">Use of intracardiac echocardiography in interventional cardiology: working with the anatomy rather than fighting it.</a> Circulation. 137 (21), 2278-2294 (2018).</li></ol>

作者没有利益冲突需要声明。

心内超声心动图（ICE）是一种非接触式三维重建工具。它确定了合适的消融平面，并降低了肺静脉狭窄的发生率。此外，ICE 通过评估消融导管的远端位置及其与解剖结构的相对关联来提高导管消融的有效性。这些结构包括左心房和肺静脉以及肺静脉的直径和形态。
ICE引导的心房颤动导管消融术可以减少术中X线照射，减少房间隔穿刺时间，发现早期并发症，并提供及时治疗，...

心房颤动 （AF） 通常与心房重塑有关，包括机械重塑、电生理重塑和结构重塑1。结构重塑将极大地影响中庭的解剖结构。因此，评估 AF 患者的左心房解剖结构对于 AF 消融手术和任何针对左心房的手术都是必不可少的。对于FAM三维建模，通过不断置换心脏中的磁导管，根据其位置对应于固定磁场的空间位置变化，重建心脏的三维建模。相比之下，ICE 3D 建模通过将传感器定位在 ICE 相控阵导管的头端，将心腔中的二维图像与 3D 电解剖映射系统集成在一起。因此，超声扇区表示 3D 建模，以展示解剖关系和实时导管位置。
根据我们的临床经验，心内超声心动图（ICE）可以识别心房壁边界，并进一步建立3D重塑。然而，在 AF 消融或 3D 重塑期间，大多数 ICE 使用仅提供心房或肺静脉的简要轮廓。最初，ICE用于指导房间隔缺损和卵圆孔未闭2的介入闭合。ICE 可以明确房间隔的位置和形状，并已用于需要房间隔穿刺的各种介入手术3.这些包括心房颤动的射频导管消融术、二尖瓣介入治疗等。 ICE可以精确识别肺静脉边界和心房壁，以建立更详细的3D模型3。目前尚不清楚这种方法是否可以为操作者提供更精确的心房解剖学评估，特别是对于肺静脉、胃窦和经鼻中隔部位。在这项研究中，我们比较了使用传统方法和精确 ICE 程序建立的左心房 CT 图像和 3D 重塑，以确定更多信息。

<table><tbody><tr><td>CARTO V6</td><td>Johnson&amp;amp;Johnson</td><td>6.0.80.45</td><td></td></tr><tr><td>CARTO V7</td><td>Johnson&amp;amp;Johnson</td><td>7.1.80.33</td><td></td></tr><tr><td>PACS system</td><td>Philips(China) Investment Co.,Ltd</td><td>N/A</td><td></td></tr><tr><td>Soundstar</td><td>Johnson&amp;amp;Johnson</td><td>N/A</td><td></td></tr></tbody></table>

three-dimensional modeling of the left atrium and pulmonary veins with a precise intracardiac echocardiography approach

心内超声心动图 （ICE） 是一种用于估计肺静脉隔离手术期间心脏解剖结构的新工具，尤其是左心房 （LA） 解剖结构和肺静脉结构。ICE广泛用于在消融过程中建立三维（3D）左心房结构模型。然而，目前尚不清楚在精确的 3D 建模方法中使用 ICE 是否可以提供更准确的左心房 3D 模型和经鼻中隔入路。本研究提出了一种使用 ICE 和快速解剖映射 （FAM） 导管重塑对左心房和肺静脉进行建模的方案。它通过观察者评分来评估使用这两种方法生成的模型的准确性。我们纳入了 50 名接受基于 ICE 的 3D 重塑的患者和 45 名接受基于肺静脉分离程序的 FAM 3D 重塑的患者。肺静脉窦重塑是通过比较重塑和左心房计算机断层扫描血管造影 （CTA） 获得的窦面积来估计的。ICE组和FAM组的观察者得分分别为3.40±0.81分和3.02分±0.72分（P<0.05）。使用基于 ICE 和 FAM 的方法获得的肺静脉窦面积与左心房 CT 获得的面积呈相关性。然而，使用 Bland-Altman 分析，ICE 获取模型的 95% 置信区间偏差比 FAM 获取模型（分别为 -238 cm 2 至 323 cm 2 和 -363 cm 2 至 386 cm 2）更窄。因此，精密ICE在估计左心房结构方面具有很高的准确率，成为未来心脏结构估计的一种有前途的方法。

2021年1月至2022年6月，我们选取了114例在我院接受心房颤动射频消融术的患者。根据以下标准排除患者:无左心房 CT 3D 体积重建图像 （n = 11）、无经隔穿刺 ICE 图像 （n = 4） 以及左心房和肺静脉图像重建不完全 （n = 4）。最后，纳入50例ICE 3D建模患者和45例FAM3D建模患者作为对照组。
两位专业的电生理学家分析了所有的3D建模图像。我们比较了Carto建模和左心房计算机断层扫描血...

Watch this Scientific Journal Video about Advancements in Intracardiac Echocardiography for Atrial Anatomy Assessment at JoVE.com

作者聚焦:用于心房解剖评估的心内超声心动图的进展 

准确的心内超声心动图 （ICE） 在估计左心房结构方面显示出显着的准确性，这是一种有前途且有前途的心脏结构估计方法。在这里，我们提出了一种使用 ICE 和快速解剖映射 （FAM） 导管重塑对左心房和肺静脉进行三维建模的方案。

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 ...

我们的研究试图评估基于心内超声心动图的 3D 构建是否可以提高肺心房的准确性和动脉解剖学评估。心内超声心动图能够识别动脉壁边界并创建肺风的 3D 模型。最近，这已经增加，重点是使用S2经常详细的图像来准确确定动脉解剖结构。目前的实验挑战之一是准确模仿左动脉结构。然而，已经获得了有希望的结果，用作最佳的动脉成像和安全解构，具有很高的准确性，并具有未来心脏结构成像的潜力。

three-dimensional-modeling-left-atrium-pulmonary-veins-with-precise

Research

JoVE Journal

Medicine

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

771 次观看.  China-Japan Union Hospital of Jilin University. 我们的研究试图评估基于心内超声心动图的 3D 构建是否可以提高肺心房的准确性和动脉解剖学评估。心内超声心动图能够识别动脉壁边界并创建肺风的 3D 模型。最近，这已经增加，重点是使用S2经常详细的图像来准确确定动脉解剖结构。目前的实验挑战之一是准确模仿左动脉结构。然而，已经获得了有希望的结果，用作最佳的动脉成像和安全解构，具有很高的准确性，...

视频: 作者聚焦:用于心房解剖评估的心内超声心动图的进展 

Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks. Bronchial thermoplasty is delivered by the Alair System and is performed in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes. After all three procedures are performed the bronchial thermoplasty treatment is complete.
Bronchial thermoplasty is performed during bronchoscopy with the patient under moderate sedation. All accessible airways distal to the mainstem bronchi between 3 and 10 mm in diameter, with the exception of the right middle lobe, are treated under bronchoscopic visualization. Contiguous and non-overlapping activations of the device are used, moving from distal to proximal along the length of the airway, and systematically from airway to airway as described previously. Although conceptually straightforward, the actual execution of bronchial thermoplasty is quite intricate and procedural duration for the treatment of a single lobe is often substantially longer than encountered during routine bronchoscopy. As such, bronchial thermoplasty should be considered a complex interventional bronchoscopy and is intended for the experienced bronchoscopist. Optimal patient management is critical in any such complex and longer duration bronchoscopic procedure. This article discusses the importance of careful patient selection, patient preparation, patient management, procedure duration, postoperative care and follow-up to ensure that bronchial thermoplasty is performed safely.
Bronchial thermoplasty is expected to complement asthma maintenance medications by providing long-lasting asthma control and improving asthma-related quality of life of patients with severe asthma. In addition, bronchial thermoplasty has been demonstrated to reduce severe exacerbations (asthma attacks) emergency rooms visits for respiratory symptoms, and time lost from work, school and other daily activities due to asthma.

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

支气管Thermoplasty：严重哮喘的一种新的治疗方法

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

科研

医学

Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens

A detailed understanding of the complexity and relative variability within the human cardiac venous system is crucial for the development of cardiac devices that require access to these vessels. For example, cardiac venous anatomy is known to be one of the key limitations for the proper delivery of cardiac resynchronization therapy (CRT)1 Therefore, the development of a database of anatomical parameters for human cardiac venous systems can aid in the design of CRT delivery devices to overcome such a limitation. In this research project, the anatomical parameters were obtained from 3D reconstructions of the venous system using contrast-computed tomography (CT) imaging and modeling software (Materialise, Leuven, Belgium). The following parameters were assessed for each vein: arc length, tortuousity, branching angle, distance to the coronary sinus ostium, and vessel diameter.
	CRT is a potential treatment for patients with electromechanical dyssynchrony. Approximately 10-20% of heart failure patients may benefit from CRT2. Electromechanical dyssynchrony implies that parts of the myocardium activate and contract earlier or later than the normal conduction pathway of the heart. In CRT, dyssynchronous areas of the myocardium are treated with electrical stimulation. CRT pacing typically involves pacing leads that stimulate the right atrium (RA), right ventricle (RV), and left ventricle (LV) to produce more resynchronized rhythms. The LV lead is typically implanted within a cardiac vein, with the aim to overlay it within the site of latest myocardial activation. 
	We believe that the models obtained and the analyses thereof will promote the anatomical education for patients, students, clinicians, and medical device designers. The methodologies employed here can also be utilized to study other anatomical features of our human heart specimens, such as the coronary arteries. To further encourage the educational value of this research, we have shared the venous models on our free access website: <a href="http://www.vhlab.umn.edu/atlas" target="_blank">www.vhlab.umn.edu/atlas</a>.

The objective of this research is to recreate and then access the anatomy of the human cardiac venous system using 3D reconstructions generated from contrast-computed tomography scans.

人类心脏静脉系统使用对比计算机断层扫描灌注固定的标本解剖重建

A detailed  understanding of the complexity and relative variability within the human  cardiac venous system is crucial for the development of cardiac ...

生物工程

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic pressure through echocardiography, as well as to obtain measurements of the Aorta and PA diameter in mice.
Mice older than 10 d of age can be analyzed using the present technique. The technique is composed of 3 main steps: set-up, image acquisition, and image analysis. The set-up step consists of getting the mouse anesthetized with 1% isoflurane, shaving it, and taping it in a supine position to a heated EKG board where the image acquisition will take place. The image acquisition step consists of learning to identify the cardiac structures and obtaining all the required images with its correspondent probe and axis in order to be able to calculate volumes and diameters. The image analysis step consists of measuring the previously acquired images with the aid of computer software.
Advantages of the proposed technique include a fast (15 min) procedure that would allow the researcher to evaluate interventions in a non-invasive, non-terminal approach and therefore follow the same mouse over time; each mouse can be used as its own control. This fact plus having the same operator perform all the acquisition and analysis for the entire experiment minimizes the limitation of operator-dependency. The present methodology is useful for mouse researchers in cardiovascular and pulmonary medicine.

The following protocol describes the methodology for the acquisition and analysis of echocardiographic images used to obtain the Left Atrial Volume (LAV), Aorta (Ao) diameter, and Pulmonary Artery (PA) diameter in mice. This technique is a non-invasive, non-terminal procedure that allows assessment of the cardiopulmonary function.

左心房，主动脉和肺动脉的超声心动图小鼠

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic ...

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 ...

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 ...

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 ...

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale (PFO) detection, for patient selection for transcatheter ASD/PFO closure,&#160;for intraoperative guidance and for long-term follow-up. The size, shape, location and the number of the atrial communications schould be determined. The accuracy of PFO detection can be improved by using agitated saline together with maneuvers to transiently increase the right atrial (RA) pressure. The appearance of microbubbles in the left atrium (LA) within 3 cardiac cycles after opacification of the RA is considered positive for the presence of an intracardiac shunt. Three dimensional TEE identifies further septal fenestrations and describes the dynamic morphology of ASD/PFO and atrial septal aneurysm. Follow-up evaluations with TTE is recommended at 1, 6, and 12 months after the procedure, with a subsequent evaluation every year. Previous studies showed an increased incidence of atrial arrhythmias early after device closure. Speckle tracking analysis may help to understand functional left atrial remodeling following percutaneous closure and its impact on atrial arrhythmias.

Transthoracic (TTE) and transesophageal (TEE) echocardiography represent the basic imaging tools for interatrial septum examination. Three dimensional (3D) TEE provides incremental information in the assessment of the interatrial septum. Further advanced echocardiography techniques using speckle tracking echocardiography are applied for sensitive volumetric and functional assessment of the heart chambers.&#160;

经导管闭合前心房通路的超声心动图评估

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale ...

Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training physicians&#39; wire-skills as well as improving planning of interventional procedures. The aim of this study was to develop a manufacturing process of patient-specific 3D-printed models for cardiovascular interventions.
To create a 3D-printed elastic phantom, different 3D-printing materials were compared to porcine biological tissues (i.e., aortic tissue) in terms of mechanical characteristics. A fitting material was selected based on comparative tensile tests and specific material thicknesses were defined. Anonymized contrast-enhanced CT-datasets were collected retrospectively. Patient-specific volumetric models were extracted from these datasets and subsequently 3D-printed. A pulsatile flow loop was constructed to simulate the intraluminal blood flow during interventions. Models&#39; suitability for clinical imaging was assessed by x-ray imaging, CT, 4D-MRI and (Doppler) ultrasonography. Contrast medium was used to enhance visibility in x-ray-based imaging. Different catheterization techniques were applied to evaluate the 3D-printed phantoms in physicians&#39; training as well as for pre-interventional therapy planning.
Printed models showed a high printing resolution (~30 &#181;m) and mechanical properties of the chosen material were comparable to physiological biomechanics. Physical and digital models showed high anatomical accuracy when compared to the underlying radiological dataset. Printed models were suitable for ultrasonic imaging as well as standard x-rays. Doppler ultrasonography and 4D-MRI displayed flow patterns and landmark characteristics (i.e., turbulence, wall shear stress) matching native data. In a catheter-based laboratory setting, patient-specific phantoms were easy to catheterize. Therapy planning and training of interventional procedures on challenging anatomies (e.g., congenital heart disease (CHD)) was possible.
Flexible patient-specific cardiovascular phantoms were 3D-printed, and the application of common clinical imaging techniques was possible. This new process is ideal as a training tool for catheter-based (electrophysiological) interventions and can be used in patient-specific therapy planning.

Here we present development of a mock circulation setup for multimodal therapy evaluation, pre-interventional planning, and physician-training on cardiovascular anatomies. With the application of patient-specific tomographic scans, this setup is ideal for therapeutic approaches, training, and education in individualized medicine.

干预规划和培训的3D打印心血管幻影的开发与评估

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training ...

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 ...