プロジェクト番号NVKP_16-1–2016-0017(「ナショナルハートプログラム」)は、NVKP_16資金提供スキームの下で資金提供されたハンガリー国立研究開発イノベーション基金からの支援を受けて実施されました。この研究は、センメルワイス大学の治療法開発およびバイオイメージングテーマ別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技術省のテーマ別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。

プロトコルは、施設の人間の研究倫理委員会のガイドラインに従い、臨床例の患者は研究に書面によるインフォームドコンセントを与えました。
1. 技術要件
<ol><li>3Dの取得と解析には、適切なソフトウェアとハードウェアを使用してください。心エコー検査装置のECGケーブルを使用します。さらに、以下に説明する完全な3D取得プロトコルには必須です。</li>
	<li>3D取得には、3D心エコープローブと3D互換超音波装置を使用してください。3D RV体積解析には、専用のソフトウェアを使用してください。</li>
</ol>2. 買収
<ol><li>ほとんどの場合、頂端ビューを使用してRVの3D取得を実行します。LVに焦点を当てたビューとは対照的に、別の患者のポジショニングが推奨されます。正しい頂端ビュー上の1つの肋間空間に切り替えることによって実質的により良い画質を達成できる場合、この短縮されたビューは、より良い3D画質を可能にし得る。縮み率は、3D 解析中に修正できます。<ol><li>左外側褥瘡位(左腕を頭の上に伸ばして左側に横たわっている患者)が推奨される標準的な根尖心エコー取得と比較して、トランスデューサーのより横方向の位置を可能にするために、患者をわずかに後ろに傾けてもらいます。</li>
		<li>RVのみを含む画像深度を選択します。 不必要に奥行きが大きいと、RV体積分析に関する有益な効果がないため、取得フレームレートが低下する可能性があります。</li>
	</ol></li>
	<li>2D心エコー画像から正しいRVフォーカスビューを確認します。このビューからでもRVの自由壁の視覚化が不十分な場合、期待される3D画質はさらなる分析に最適ではありません。</li>
	<li>4Dボタンを使用してライブ 3D イメージングに切り替え、RVビューをさらに修正することができます。</li>
	<li>3Dライブモードは見た目に非常に美しいかもしれませんが、 3D ビューには 12スライス モードを使用して、関心領域の三葉機画像と自由に変更できる9つの断面面を表示します。切断面の回転と正しい位置により、RVフリーウォール全体(流出路と先端セグメントを含む)の可視性を確認します。</li>
	<li>セクターの左傾化(タッチスクリーンの2ページ目)を使用して画像をさらに調整し、RVの視覚化を改善します。</li>
	<li>RV体積解析には、 マルチ ビートモードと シングルビート モードの2つの3D取得モードを使用します。ただし、すべての患者でこれらのアプローチの両方を使用しますが、場合によっては(例:.、特定の不整脈、患者の重度の呼吸困難)、後者のみが実行可能な場合があります。.</li>
	<li>シングルビートモードを使用して、画質とフレームレートのトレードオフを実現します。最適な画像深度、幅、フレームレート(タッチスクリーンの下部パネル)を選択し、それ以上のアクションなしでRVの3Dループを取得します。この方法は大多数の患者で実行可能です。ただし、マルチビートアプローチと比較して、一般的に画質とフレームレートが低くなります。<ol><li>平均心拍数(60〜70 /分)の場合、適切なRV分析のために、フレームレートの下限を16フレーム/秒に保ちます。ただし、頻脈が存在する場合は、さらに高いフレームレートをお勧めします。</li>
	</ol></li>
	<li>マルチビートモードを使用して、タッチスクリーンで選択できる所定の数の心臓サイクルから取得した3Dループを再構築します(2、3、4、6 ビート モードを使用できます)。シングルビート取得とは対照的に、一般的により良い画質とフレームレートが期待されます。ただし、比較的一定の心周期の長さと、必須の息止め操作による患者のコンプライアンスが必要です。操作は、いわゆるステッチアーティファクトを回避するために不可欠です:取得した3Dボリュームが一緒にステッチされると、不均等な心周期の長さおよび/または呼吸による動きがこの現象を引き起こす可能性があります。<ol><li>プローブの正しい位置と機械の設定(「シングルビート」モードと同様)の後、患者に深呼吸をして保持するように依頼します。この場合、拡張肺は通常画像全体を覆います。</li>
		<li>患者に、厳密にガイダンスを付けてゆっくりと息を吐くように依頼します。肺の収縮と並行して、RVは再び見えるようになります。</li>
		<li>RV全体(自由壁と中隔)が再び現れたら、この状態で息を止めるように患者に依頼します。</li>
		<li>画面上で マルチビート をクリックして取得を開始すると、指定された量の心臓サイクル中に3Dループが蓄積されます。</li>
		<li>取得の準備ができたら(RV全体が視覚化されます)、患者に再び自由に呼吸するように依頼します。</li>
		<li>取得したループをチェックして、ステッチングやドロップアウトアーティファクトがないかどうかを確認します。</li>
	</ol></li>
</ol>3. 4D RV解析
<ol><li>専用ソフトウェアを使用して、RVの3D体積解析を実行します。患者ライブラリからRVに焦点を当てた3Dループを選択した後、ボリュームフォルダにある測定ウィンドウからソフトウェアを開きます。</li>
	<li>ソフトウェアを開いた後、RVを4つの事前定義された切断面に向けます。<ol><li>左上下の長軸平面の三尖弁の中心に2つのマーカー(TVセンター)を配置します。回転ツールを使用して、画像の長軸をRVの実際の長軸に調整します。右上の参照画像は、正しい向きがどのように表示されるかを示しています。</li>
		<li>右上のパネルで、回転によって短軸画像を正しい位置に揃えます。前の手順と同様に、参照画像もこのプロセスに役立ちます。</li>
	</ol></li>
	<li>完了したら、[ ランドマークの設定 ] をクリックして解析の次のステップに進みます。2つの画像にランドマークを設定します。<ol><li>左側で、自由壁(TVフリーウォール)とセプタム(TVセプタム)の三尖弁輪と、以前に配置された頂端4室ビューのRV頂点をマークします。</li>
		<li>右側で、RVの後方(LV / RV後方)と前方挿入点(LV / RV前方)とRV自由壁(RV自由壁)を設定します。前のウィンドウと同様に、右上隅の参照画像は、正しいセットアップに関するヘルプです。すべてのランドマークを設定した後、ソフトウェアは自動的に次のウィンドウ(レビュー)にジャンプします。</li>
	</ol></li>
	<li>このウィンドウ(レビュー)で、必要に応じて、心周期全体を通して心内膜境界の自動検出を確認し、手動で修正します。デフォルトでは、9つのパネルを見ることができます:左側に3つの移動ループ(1つの長軸と2つの短軸)、中央に同じ画像の拡張末期フレーム、右側に収縮期末期のフレーム。<ol><li>誤った追跡の場合は、心内膜の境界(緑色の線)、追跡された境界をクリックして自由に修正します。短軸の回転ツールを使用して、RVの全周に沿って追跡する画像を確認します。 右側のパネルで[ ペンサイズ ]を選択して、補正の大きさを調整します。トラッキングが正しいと思われる場合は、同じパネルの[ 結果 ]をクリックします。</li>
	</ol></li>
	<li>最後のセクションでは、右上(ワークシートパネル )で最終的な3D体積データとその他の計算パラメータを確認します。RV容量と排出率に加えて、ソフトウェアは、線形(中軸、基礎、長軸)直径などの2Dパラメータ、および事前定義された頂端4チャンバービューから得られたFACおよびTAPSE値も表示します。ソフトウェアはまた、RVの長軸と短軸(左側)、RVの3Dライブモデル(中央上)、およびチャンバーの体積-時間曲線(右下)も表示します。<ol><li>追跡をさらに調整する必要がある場合は、右側のパネルでクリックすることで、以前のすべての手順を修正できます。トラッキングと3Dパラメータが有効であると考えられる場合は、同じパネルの[承認して終了]をクリックして結果を保存します。</li>
	</ol></li>
</ol>

<ol>
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RVの3D分析は、日常の心臓病学の実践における重要なステップを表しています。以前は無視されていた心腔の形態と機能への関心の高まりと並行して、これらの新しいソリューションは、心臓の右側に関する臨床的に意味のある情報を提供します。3D取得には、2D心エコー画像とは著しく異なるいくつかの側面がありますが、重要なポイントに特別な注意を払い、徹底したプロトコルを使用す?...

心エコー検査は、1950年代の最初の臨床応用から長い道のりを歩んできました1。最初の1次元超音波プローブは、チャンバーの壁と内腔の単純な直線直径を提供するように設計されました。しかし、それらは間違いなく心臓血管イメージングのマイルストーンを表しています。2次元(2D)超音波イメージングの開発は、形態と機能のはるかに正確な定量化を提供することによるもう一つの大きなステップであり、今でも日常の臨床診療における標準的な方法であると考えられています。それにもかかわらず、2D心エコー検査ベースの評価は依然として技術の主要な制限を伴います:いくつかの断層平面からの所与のチャンバーのイメージングは、3次元(3D)構造の形態および機能を適切に特徴付けない。この問題は、右心室(RV)の場合にさらに顕著である:比較的単純な弾丸型の左心室(LV)と比較して、RVは、線形直径または領域3を使用して適切に定量化できない複雑な形状2を有する。これらの広く知られている事実にもかかわらず、RVの形態および機能は通常、臨床診療においてそのような単純なパラメータによって測定される。
何十年もの間、RVは左のRVと比較して流通においてはるかに重要ではないと考えられていました。いくつかの画期的な論文は、RVの形状と機能の強力な予後的役割を示すこの立場を打ち負かしました4,5,6,7。多くの研究により、比較的単純な従来のパラメータを使用してもRV測定の増分値が実証されており、潜在的に意味のある臨床的価値を持つチャンバーをより正確に定量することの重要性と必要性が浮き彫りになっています。
3D心エコー検査は、心腔の2D評価のいくつかの制限を克服します。LVの場合も、体積の測定や幾何学的仮定のない機能パラメータは高い関心事になる可能性がありますが、RV8の評価では特に重要になる可能性があります。3D由来のRV体積および駆出率(EF)は、様々な心血管状態において有意な予後値を有することが示されている9、10。
現在、いくつかのベンダーは、ゴールドスタンダードの心臓磁気共鳴(MR)測定に対して検証された結果を備えた3D RV評価用の半自動ソリューションを提供しています11,12。3D評価の技術的要件は、今日の最先端の心臓血管イメージング部門の重要な部分であり、まもなくすべての心エコー検査ラボの一般的な機器の一部になると予想されています。3D取得と後処理に関する適切な専門知識があれば、3D RV分析を標準検査プロトコルに簡単に実装できます。

<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 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

伝統的に、心臓の右側は循環において小さな役割を果たすと考えられていました。しかし、ますます多くのデータが、右心室(RV)機能がさまざまな心血管障害において強力な診断力と予後力を持っていることを示唆しています。その複雑な形態と機能のために、従来の2次元心エコー検査によるRVの評価は限られています:日常の臨床診療は通常、単純な線形寸法と機能的測定に依存しています。3次元(3D)心エコー検査は、幾何学的仮定のないRVの体積定量を提供することにより、これらの制限を克服しました。ここでは、市販の主要なソフトウェアを使用してRVの3D心エコーデータを取得および分析するためのステップバイステップガイドを提供します。3D RVボリュームと排出率を定量化します。いくつかの技術的側面は、RVの取得と分析の品質を向上させるのにも役立つ可能性があり、実用的な方法で提示します。この方法の現在の機会と制限要因を確認し、現在の臨床診療における3D RV評価の潜在的なアプリケーションも強調します。

RVの3D分析は、さまざまな心血管疾患で実行可能です。症例1は、正常な心室容積と機能を持つ健康なボランティアです(図1)。症例2は僧帽弁修復後の患者で,従来の2D評価の相反する結果の典型例であり,TAPSEは著しく低下しているが,RV機能障害の徴候は見られず,正常な3D RV EFによりRVの全体的な収縮機能が維持されていることが確認された(<strong class...

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

ここでは、主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て、右心室の3D体積評価のための段階的な取得および分析プロトコルを提供します。

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 ...

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

Research

JoVE Journal

Medicine

2.8K ビュー.  Semmelweis University Heart and Vascular Center. ここでは、主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て、右心室の3D体積評価のための段階的な取得および分析プロトコルを提供します。

ビデオ: 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.

マウスの右心の心エコー評価

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

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.

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 ...

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.

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 ...

生物工学

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 ...

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.

マウスにおける右心室拡張期パラメータの心エコー測定

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 ...

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.

マウスにおける閉鎖胸腔カテーテル法による心機能および圧力容積ループの両心室評価

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 ...

左心房と肺静脈のICEベースの3Dリモデリング

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.

著者スポットライト:心房解剖学評価のための心臓内心エコー検査の進歩 

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.

精密な心臓内心エコー法による左心房と肺静脈の3次元モデリング

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