プロジェクトいいえ。NVKP_16-1-2016-0017('ナショナル・ハート・プログラム')は、ハンガリーの国立研究開発・イノベーション基金から提供された支援を受けて実施され、NVKP_16資金制度の下で資金提供を受けています。この研究は、センメルワイス大学の治療開発とバイオイメージングテーマプログラムの枠組みの中で、ハンガリーのイノベーションと技術省のテーマ・エクセレンス・プログラム(2020-4.1.1.-TKP2020)によって資金提供されました。

この議定書は、センメルワイス大学の地域・学術研究倫理委員会のガイドラインに従っています。現在のプロトコルは、特定のベンダーに適用されます。いくつかのステップは、超音波機械と後処理ソフトウェアに関係なく有効なままですが、他のベンダーのソリューションを使用する場合、重要な違いが存在する可能性があります。
1. 技術的な要件
<ol><li>3Dイメージングが可能な心エコー検査機を利用する。</li>
	<li>3Dトランスソシック心エコー検査に対応したフェーズドアレイトランスデューサを接続します。</li>
	<li>超音波システムの内蔵3リードECGを適用して、システムが記録と分析を心臓周期に同期できるようにします。</li>
</ol>2. 3次元心エコー画像の取得
<ol><li>左横の褥瘡の位置に患者を配置する(患者は、左の側に横たわって、頭の上に左腕を伸ばした)。</li>
	<li>画面上の ECG トレースの品質が良好であることを確認します。 注:ソフトウェアは心電図信号に基づいて心周期のさまざまなポイントを検出するので、これは後処理のための前提条件です。</li>
	<li>画像を凍結解除し、トランスデューサで患者を検査し始めます。従来のアペカル4室ビューを視覚化します。</li>
	<li>セクタ幅をLVに調整し、深さを下げて左心房を切り詰め、わずかな過ゲインを使用して画質を最適化します。 注意:LVの全端を確認し、また心外膜面が見えるようにしてください。</li>
	<li>4Dボタンを押して3Dモードに切り替えます。 注: タッチスクリーンの マルチスライス ボタンを押すと、標準の短軸と長軸カットを使用して3Dデータセットの概要を表示する4つのオプション(5、7、8、12スライス)が利用可能になります。必要に応じて、トランスデューサの位置を補正して、円錐から僧帽弁レベルまでのLVの壁厚全体をピラミッド型3Dデータセットに確実に含めることができます。12 個のスライス (9 つの調整可能な短軸ビュー) の使用をお勧めします。</li>
	<li>マルチビートまたはシングルビートモードを使用して3D画像を取得します。<ol>
<li>マルチビートモードを使用して、2、3、4、または6の心拍サイクル(これは画面上で設定することができます)からデータセットを再構築する、より高い空間および時間分解能を達成するために使用してください - ステッチアーティファクトを最小限に抑えるために必要な患者と安定したトランスデューサ位置の終わりの息止め。 注: シングルビート の取得は、より低い空間と時間分解能です。しかし、ほとんどの最新のトランスデューサは高品質であるため、再構築せずに適切な3Dデータセットを取得してさらなる分析を行うことができます。一般的な推奨事項として、1 秒あたりのボリューム レートは、さらに分析するために推奨されます。</li>
		<li>フルボリュームがサブボリュームから再構築され、LV全体が表示されたら、イメージをフリーズします。 サイクル選択 と サイクル数ノブを 使用して、最適な取得した心臓サイクルを選択し、 イメージストアを押します。 注: ステッチアーティファクトは、空間的または一時的に位置がずれるサブボリューム同士です。LV 壁の大きなドロップアウトを持つデータセットや、ステッチアーティファクトを含むデータセットは、一般に、さらなる分析には適していません。すでに取得した 3D データセットの品質は、マルチスライス モードを使用してダブルチェックできます。</li>
	</ol>
</li>
</ol>3. LV形態と機能を定量化するための後処理
<ol><li>さらに解析に適した 3D データセットを選択します。 注:プロトコルのこの部分は、以前に取得し、良質の3D画像を保存する必要があり、超音波装置と別のワークステーション上で実行することができます。</li>
	<li>[測定]|をクリックします。ボリューム、4DオートLVQを選択します。</li>
	<li>クワッドスクリーン(4、2、3室のビュー、および1つの短軸ビューの3つの補助的なビュー)では、後者は長軸ビュー上の水平面で調整できます。</<c0>a0>必要に応じて、傾きと回転によって手動でアパイカルビューを修正し、対応する標準ビューを表示し、それによって短縮を排除します。長軸ビューでキャリパーをドラッグして移動することで、キャリパーを LV の長軸に合わせて傾斜を設定します。マシン上の対応するまたはすべての回転ノブまたは短軸イメージのキャリパーを調整することによって、回転を設定します。 注: ソフトウェアの推奨設定は 、[自動整列 ] ボタンを押してリセットできます。</li>
	<li>ビューの配置が完了したら、次のステップ EDV をクリックします。エンド拡張(ED)フレームは、ECG信号を使用して自動的に検出されますが、必要に応じて手動で修正することができます。</li>
	<li>LV内膜・外膜表面の半自動検出<ol><li>任意のアプカル ビューで 2 つのランドマーク ポイントを手動で選択します。まず、LV頂点を特定し、次にLVベースの中央(僧帽弁アヌラスレベル)を任意のアピックビューで識別します。アルゴリズムは、自動的に全体のLVの心内境界を輪郭を描きます。 注:2つのオプションがあります: 手動、つまり、2つの基礎と1つのアペカルランドマークは、すべてのアパイカルビューで設定する必要があることを意味し、 自動Initは、ユーザーの操作なしで自動的にLVを輪郭を描きます。</li>
		<li>3 つのアペカル ビュー、異なるレベルの 3 つの短軸ビュー、および第 4 のユーザー制御短軸で輪郭の信頼性を確認して、検出されたサーフェスの視覚的な検証を可能にします。輪郭補正は、手動でポイントを追加することで可能で、その後、コンター ラインに組み込まれます。 注: [元に戻す]を使用すると、以前に追加したポイントを削除できます。リセットボタンは、輪郭をリセットして、セクション全体を最初から開始します。輪郭の可視性を調整して、グレースケールの画像上の心内膜表面の鑑賞を可能にできます。心内膜および心筋輪郭は、正確かつ一貫した方法で行われるべきである。詳細な推奨事項については、以下の参照を確認してください。</li>
		<li>次のステップ( ESV)を選択します。</li>
		<li>前のポイントで説明したように、同じ手順(3.5.1~3.5.2)を繰り返して、エンドシストリックフレームの心内輪郭を特定して修正します。 メモ:エンドシストリック(ES)フレームは、ECG信号を使用して自動的に検出されますが、必要に応じて手動で修正することができます。エンド拡張期容積(EDV)、終期収縮期容積(ESV)、駆出率(EF)、心拍数(HR)、脳卒中量(SV)、心拍出量(CO)および球面指数(SpI)の値が既に画面に表示されています。</li>
		<li>次のステップで 音量波形 を押します。ソフトウェアは、心周期フレーム全体にわたって心内膜表面をトレースするLVと時間容積曲線の動的3Dモデルを表示します(図1)。 注:ここでは、任意のフレームで心内膜の境界線を編集する可能性があります。</li>
		<li>次のステップでは、 LV Mass を押します。ソフトウェアは自動的に末拡張期フレームのLV心外膜輪郭を輪郭を描き、LV質量(EDMass)を計算する。 注: 必要に応じて、短軸または長軸平面に含める点(前述の方法と同じ方法)を追加して、心外膜サーフェスの輪郭を編集します。調整する輪郭を選択できます: 内線、エピ、または Endo +エピ。</li>
		<li>次のステップに向けて 4D ひずみ ROI を押します。ソフトウェアは自動的に終部収縮期フレームのLV心外膜輪郭を輪郭し、LV末端収縮量質量(ESMass)を計算する。 注: 必要に応じて、短軸または長軸面に含める点(前述と同じ方法)を追加して、心外膜サーフェスの終点-収縮期の輪郭を編集します。ESMass は、EDMass と同様の値である必要があります。このステップは、スペックルトラッキングによって3Dひずみ値を計算するために不可欠です。</li>
		<li>次のステップで 4Dひずみ結果 を押します。ソフトウェアは、複数の短軸および長軸平面上の3D心筋追跡と、心臓サイクル全体の17の標準LVセグメントの対応する歪み値をフレームごとに視覚化します。時間ひずみ曲線と雄牛の目のプロットも表示されます。縦方向ひずみ、円周ひずみ、放射状ひずみ、面積ひずみ、回転、およびトーションのパラメータが計算され、実証できます。 注:特定のLVセグメントが画像の視覚的観察や時間ひずみ曲線に基づいて低いトラッキング品質を有すると考えられる場合は、解析から特定のLVセグメントを除外する可能性があります。ただし、ソフトウェアは、デフォルトでセグメントの承認または拒否を推奨します。色分け歪み値は、LVの動的3Dモデルで「レイアウト」を変更することで可視化できます。</li>
	</ol></li>
	<li>分析を終了するには、[ 承認と終了] を押します。</li>
</ol>

<ol>
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LV形態学的および機能的測定は、心臓病の診断、管理、およびフォローアップの基礎を表します。さらに、それらは結果の強力な予測変数です。一般的に、LVの2D心エコーベースの評価は、現在の実践ガイドラインで推奨されています。しかし、3D心エコーは、LV shape7,8に関する幾何学的仮定から解放され、より正確であることが証明されています。?...

左心室(LV)形態および機能の評価は、心臓病学における一般的かつより具体的な調査の主な目的である1。情報の高密度を提供することができる広く利用可能で非侵襲的な胸部心エコー検査(TTE)は、便利で迅速で費用対効果の高い評価のための選択の方法です。
LV質量、体積、および後続の放出率の測定は、有意な診断および予後値2を保持します。与えられたメジャーが正確であればあるほど、その値は高くなります。金標準心臓磁気共鳴(CMR)の画像化の派生値とのよりよい相関関係は、心エコー技術のための継続的な追跡である。一般的に、臨床実習ガイドラインでは、LV容積および駆出率測定3のための複葉機シンプソンの方法をお勧めします。しかし、LVは不規則な形状を持つ3次元(3D)構造であるため、LVの形態や機能を正確に表現するためにいくつかの臨床シナリオでは、いくつかの断層面が失敗することは間違いありません。超音波ハードウェアおよびソフトウェア技術の最近の進歩は、心エコープロトコルを革命化するリアルタイム3Dイメージングの開発を可能にしました。
また、壁運動異常に関する定量的アプローチの必要性は、変形画像化4の台頭をもたらした。ひずみとひずみ率のパラメータは、標準のグレースケール画像を使用してスペックルトラッキングで計算できます。3D心エコー検査は、2次元歪み評価5のいくつかの欠点を克服することもできる。高価な科学的ツールから、3D心エコーは日常の臨床現場で使用される強力な技術になり始め、LVの定量化は確かにこのブレークスルーの最初の行にあります。
本稿は、ヒントやトリックを提示し、また、LVに関するこの重要な技術の広範だが技術的に健全な使用を容易にする潜在的な落とし穴を強調することによって、詳細な3Dプロトコルを通して読者を導くことを目的としています。

<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 LVQ</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>

evaluation of left ventricular structure and function using 3d echocardiography

左心室(LV)の3次元(3D)定量化は、様々な心臓障害における診断精度と正確なリスク階層化の点で有意な付加価値を提供する。最近では、3D心エコー検査は、日常的な心臓病の練習で利用可能になりました。ただし、高品質の画像取得とその後の解析には、学習曲線が急な値になります。本稿は、ヒントやトリックを提示し、また、LVに関するこの重要な技術の広範だが技術的に健全な使用を容易にする潜在的な落とし穴を強調することによって、詳細な3Dプロトコルを通して読者を導くことを目的としています。まず第一に、最適な空間と時間分解能を備えた高品質の3Dデータセットの取得を示します。次に、最も広く適用されている組み込みソフトウェアの1つを使用して、LVの詳細な定量化に向けた分析ステップを提示します。LV体積、球面性、質量、収縮期機能を、吐出分率と心筋変形(縦方向および経周歪み)を測定して定量化します。従来の心エコー手法から3Dベースの定量化への移行が強く推奨される重要なシナリオについて、臨床事例を紹介します。

LVの3D分析は、大多数の患者で実現可能である。ケース1は正常な心室容積と機能を有する健康なボランティアである(図1)。症例2(図2)は、拡張型心筋症を有する64歳の男性患者であり、左束枝ブロック形態の広いQRS複合体(160ms)である。ゴールドスタンダードCMR測定は以下の通り:末拡張期容積:243mL、終期収縮期容積:160mL、駆出...

Watch this Scientific Journal Video about Evaluation of Left Ventricular Structure and Function using 3D Echocardiography at JoVE.com

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

本稿では、3D心エコー検査による左心室の容積評価および分光追跡解析のためのステップバイステップの取得および分析プロトコルを提供し、特にこの技術の実現可能性を最大化する実用的な側面に焦点を当てる。

3D心エコーを用いた左心室構造と機能の評価

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

evaluation-left-ventricular-structure-function-using-3d

Research

JoVE Journal

Bioengineering

3.8K ビュー.  Semmelweis University. 本稿では、3D心エコー検査による左心室の容積評価および分光追跡解析のためのステップバイステップの取得および分析プロトコルを提供し、特にこの技術の実現可能性を最大化する実用的な側面に焦点を当てる。

ビデオ: Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

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.

マウスにおける経胸壁心エコー

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

医学

Ultrasonic Assessment of Myocardial Microstructure

Echocardiography is a widely accessible imaging modality that is commonly used to noninvasively characterize and quantify changes in cardiac structure and function. Ultrasonic assessments of cardiac tissue can include analyses of backscatter signal intensity within a given region of interest. Previously established techniques have relied predominantly on the integrated or mean value of backscatter signal intensities, which may be susceptible to variability from aliased data from low frame rates and time delays for algorithms based on cyclic variation. Herein, we describe an ultrasound-based imaging algorithm that extends from previous methods, can be applied to a single image frame&#160;and accounts for the full distribution of signal intensity values derived from a given myocardial sample. When applied to representative mouse and human imaging data, the algorithm distinguishes between subjects with and without exposure to chronic afterload resistance. The algorithm offers an enhanced surrogate measure of myocardial microstructure and can be performed using open-access image analysis software.

Echocardiography is commonly used to noninvasively characterize and quantify changes in cardiac structure and function. We describe an ultrasound-based imaging algorithm that offers an enhanced surrogate measure of myocardial microstructure and can be performed using open-access image analysis software.

心筋微細構造の超音波評価

Echocardiography is a widely accessible imaging modality that is commonly used to noninvasively characterize and quantify changes in cardiac structure and ...

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.

経胸壁心エコー検査による肺動脈狭窄のマウスモデルにおける右室の構造と機能の評価

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.

マウスの弁膜症の包括的表現型の特徴のための心エコーアプローチとプロトコル

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 ...

Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation

The value of conventional echocardiography is limited by differences in inter-individual image interpretation and therefore largely dependent on the examiners&#39; expertise. Speckle tracking Echocardiography (STE) is a promising but technically challenging method that can be used to quantitatively assess regional and global systolic and diastolic myocardial performance. Myocardial strain and strain rate can be measured in all three dimensions&#160;&#8212; radial, circumferential, longitudinal &#8212; of myocardial deformation. Standard cross-sectional two-dimensional B-mode images are recorded and subsequently postprocessed by automated continuous frame-by-frame tracking and motion analysis of speckles within the myocardium. Images are recorded as digital loops and synchronized to a 3-lead EKG for timing purposes. Longitudinal deformation is assessed in the apical 4-, 3-, and 2-chamber views. Circumferential and radial deformation are measured in the parasternal short axis plane.
Optimal image quality and accurate tissue tracking are paramount for the correct determination of myocardial performance parameters. Utilizing transthoracic STE in a healthy volunteer, the present article is a detailed outline of the essential steps and potential pitfalls of quantitative echocardiographic myocardial deformation analysis.

Speckle tracking echocardiography is an emerging diagnostic imaging technique for the quantitative assessment of global and regional myocardial performance. Standard view echocardiographic motion images are recorded and deformation parameters are subsequently measured by automated continuous frame-by-frame tracking and motion analysis of speckles within the B-mode images of the myocardium.

左心室心筋変形の定量的評価のための経胸壁スペックル追跡心エコー検査

The value of conventional echocardiography is limited by differences in inter-individual image interpretation and therefore largely dependent on the ...

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、大動脈、肺動脈のマウス心エコー

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

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.

肺静脈の特異的パラメータの可視化と評価のための3次元心エコー法

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

生物工学

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.

成人ラットにおける心臓解剖学と機能の心エコー評価

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

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.

3次元心エコー検査を用いた右心室の形態学的・機能的評価

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.