Projeto nº. NVKP_16-1-2016-0017 («Programa Nacional do Coração») foi implementado com o apoio do Fundo Nacional de Investigação, Desenvolvimento e Inovação da Hungria, financiado ao abrigo do regime de financiamento NVKP_16. A investigação foi financiada pelo Programa Temático de Excelência (2020-4.1.1.-TKP2020) do Ministério da Inovação e Tecnologia da Hungria, no âmbito dos programas temáticos de Desenvolvimento Terapêutico e Bioimagem da Universidade Semmelweis.

O protocolo segue as diretrizes do comitê de ética em pesquisa com seres humanos da instituição e os pacientes dos casos clínicos assinaram o termo de consentimento livre e esclarecido para o estudo.
1. Requisitos técnicos
<ol><li>Para aquisição e análise 3D, use software e hardware apropriados. Use cabos de ECG do aparelho de ecocardiografia; além disso, é obrigatório para o protocolo completo de aquisição 3D descrito abaixo.</li>
	<li>Para aquisição 3D, use uma sonda ecocardiográfica 3D e uma máquina de ultrassom compatível com 3D. Para análise volumétrica de RV 3D, use um software dedicado.</li>
</ol>2. Aquisição
<ol><li>Na grande maioria dos casos, realizar a aquisição 3D do VD utilizando vistas apicais. Em oposição às visões focadas no VE, recomenda-se um posicionamento diferente do paciente. Se uma qualidade de imagem substancialmente melhor puder ser alcançada alternando para um espaço intercostal sobre a visão apical correta, essa visão encurtada pode permitir uma melhor qualidade de imagem 3D. O encurtamento pode ser corrigido durante a análise 3D.<ol><li>Em comparação com a aquisição ecocardiográfica apical padrão, onde a posição de decúbito lateral esquerdo (paciente deitado do lado esquerdo com o braço esquerdo esticado acima da cabeça) é recomendada, faça com que o paciente se incline um pouco mais para trás para permitir uma posição mais lateral do transdutor.</li>
		<li>Escolha uma profundidade de imagem que inclua apenas o RV. A profundidade desnecessariamente grande pode diminuir a taxa de quadros de aquisição com a falta de efeitos benéficos em relação à análise volumétrica do RV.</li>
	</ol></li>
	<li>Confirme a visão correta focada no RV a partir de imagens de ecocardiografia 2D. Se a parede livre do RV for mal visualizada, mesmo a partir dessa visão, a qualidade de imagem 3D esperada não será ideal para análises posteriores.</li>
	<li>Mude para a imagem 3D ao vivo usando o botão 4D , onde a correção adicional da visão RV pode ser realizada.</li>
	<li>Embora o modo ao vivo 3D possa ser bastante agradável esteticamente, use o modo 12 Slice para a visualização 3D, que mostra uma imagem triplana da região de interesse, bem como 9 planos transversais que podem ser modificados livremente. Por rotação e posicionamento correto dos planos de corte, confirme a visibilidade de toda a parede livre de RV (incluindo a faixa de saída e os segmentos apicais).</li>
	<li>Ajuste ainda mais a imagem usando a inclinação esquerda do setor (segunda página na tela sensível ao toque) para melhorar a visualização do RV.</li>
	<li>Use dois modos de aquisição 3D para análise volumétrica RV: o modo multi beat e o modo single beat . Use ambas as abordagens em todos os pacientes, no entanto, em alguns casos (por exemplo, certas arritmias, dispneia grave do paciente), apenas a última pode ser viável.</li>
	<li>Usando o modo de batida única , obtenha uma troca entre a qualidade da imagem e a taxa de quadros. Escolha uma profundidade, largura e taxa de quadros de imagem ideais (painel inferior da tela sensível ao toque) e obtenha loops 3D do RV sem qualquer ação adicional. Este método é viável na maioria dos pacientes; no entanto, ele produz geralmente menor qualidade de imagem e taxa de quadros em comparação com a abordagem multi beat .<ol><li>No caso de uma frequência cardíaca média (60-70/min), mantenha um limite de frequência de quadros mais baixo de 16 quadros/s para uma análise adequada do VD; no entanto, se a taquicardia estiver presente, recomendam-se taxas de quadros ainda mais altas.</li>
	</ol></li>
	<li>Usando o modo multi beat , reconstrua o loop 3D adquirido a partir de um determinado número de ciclos cardíacos que podem ser selecionados na tela sensível ao toque (os modos de 2,3,4 e 6 batimentos podem ser usados). Em contraste com a aquisição de batida única, geralmente espera-se melhor qualidade de imagem e taxa de quadros; no entanto, requer comprimentos de ciclo cardíaco relativamente constantes e também a adesão do paciente devido à manobra obrigatória de apneia. A manobra é essencial para evitar os chamados artefatos de costura: quando o volume 3D adquirido é costurado, comprimentos de ciclo cardíaco e/ou movimento desiguais devido à respiração podem resultar nesse fenômeno.<ol><li>Após o posicionamento correto da sonda e a configuração da máquina (semelhante ao modo de "batida única"), peça ao paciente para respirar fundo e segurá-la. Neste caso, os pulmões em expansão geralmente cobrem toda a imagem.</li>
		<li>Peça ao paciente para expirar lentamente, estritamente com orientação. Em paralelo com a deflação dos pulmões, o VD torna-se visível novamente.</li>
		<li>Quando todo o VD (parede livre e septo) reaparecer, peça ao paciente para prender a respiração neste estado.</li>
		<li>Ao clicar em multi batida na tela, inicie a aquisição e o loop 3D se acumula durante a quantidade determinada de ciclos cardíacos.</li>
		<li>Quando a aquisição estiver pronta (todo o VD é visualizado), peça ao paciente para respirar livremente novamente.</li>
		<li>Verifique o loop obtido para garantir se não há artefatos de costura ou desistência.</li>
	</ol></li>
</ol>3. Análise 4D RV
<ol><li>Usando um software dedicado, realize análises volumétricas 3D do RV. Depois de escolher o loop 3D focado em RV na biblioteca do paciente, abra o software na janela Medição encontrada na pasta Volume .</li>
	<li>Depois de abrir o software, oriente o RV em quatro planos de corte predefinidos.<ol><li>Coloque dois marcadores (TV Center) no centro da válvula tricúspide nos planos superior e inferior esquerdo de eixo longo. Ajuste o eixo longo da imagem para o eixo longo real do RV usando a ferramenta de rotação. As imagens de referência nas bordas superiores direitas mostram como a orientação correta deve aparecer.</li>
		<li>Nos painéis superior e inferior direito, alinhe as imagens de eixo curto na posição correta por rotação. Da mesma forma que a etapa anterior, as imagens de referência também ajudam nesse processo.</li>
	</ol></li>
	<li>Depois de concluir, clique em Definir pontos de referência para a próxima etapa da análise. Defina pontos de referência em duas imagens.<ol><li>No lado esquerdo, marque o anel tricúspide na parede livre (parede livre de TV) e septo (septo de TV) e o ápice do VD na visão apical de quatro câmaras previamente orientada.</li>
		<li>No lado direito, coloque-se os pontos de inserção posterior do VD (VE/VD posterior) e anterior (VE/VD anterior) e a parede livre do VD (parede livre do VD). Da mesma forma que a janela anterior, as imagens de referência no canto superior direito ajudam a verificar a configuração correta. Depois de definir todos os pontos de referência, o software salta automaticamente para a próxima janela (Revisão).</li>
	</ol></li>
	<li>Nesta janela (Revisão), revise e corrija manualmente a detecção automática da borda endocárdica ao longo de todo o ciclo cardíaco, se necessário. Por padrão, 9 painéis podem ser vistos: no lado esquerdo, 3 loops móveis (1 eixo longo e 2 eixo curto), no meio os quadros diastólicos finais das mesmas imagens e no lado direito os sistólicos finais.<ol><li>No caso de rastreamento falso, corrija livremente as bordas endocárdicas (linhas verdes), a borda rastreada clicando nelas. Usando a ferramenta de rotação no eixo curto, revise o rastreamento de imagens ao longo de toda a circunferência do RV. Ajuste a magnitude da correção escolhendo o tamanho da caneta no painel do lado direito. Se o rastreamento for considerado correto, clique em Resultados no mesmo painel.</li>
	</ol></li>
	<li>Na última seção, revise os dados volumétricos 3D finais e outros parâmetros calculados no lado superior direito (painel Planilha ). Além dos volumes RV e da fração de ejeção, o software também exibe parâmetros 2D, como diâmetros lineares (médios, basais e de eixo longo), bem como valores FAC e TAPSE derivados da visualização apical de quatro câmaras predefinida. O software também mostra um eixo longo e curto do RV (lado esquerdo), um modelo 3D ao vivo do RV (meio superior) e uma curva volume-tempo da câmara (inferior direita).<ol><li>Em caso de necessidade de mais ajustes no rastreamento, todas as etapas anteriores estão disponíveis para correção, clicando nelas no painel direito. Se o rastreamento e os parâmetros 3D forem considerados válidos, salve os resultados clicando em "Aprovar e sair" no mesmo painel.</li>
	</ol></li>
</ol>

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A análise 3D do VD representa um passo importante na prática cardiológica cotidiana. Paralelamente ao crescente interesse da morfologia e função da câmara cardíaca anteriormente negligenciada, essas novas soluções fornecem informações clinicamente significativas sobre o lado direito do coração. Embora a aquisição 3D tenha vários aspectos que diferem marcadamente da imagem ecocardiográfica 2D, mantendo atenção especial aos pontos críticos e usando um protocolo completo, a análise 3D do VD pode progred...

A ecocardiografia percorreu um longo caminho desde suas primeiras aplicações clínicas na década de 19501. As primeiras sondas de ultrassom unidimensionais foram projetadas para fornecer diâmetros lineares simples das paredes da câmara e lúmens; no entanto, eles representam, sem dúvida, um marco na imagem cardiovascular. O desenvolvimento da ultrassonografia bidimensional (2D) foi outro passo importante, fornecendo uma quantificação muito mais precisa da morfologia e da função, e ainda é considerado o método padrão na prática clínica cotidiana. No entanto, a avaliação baseada em ecocardiografia 2D ainda carrega uma grande limitação da técnica: a imagem de uma determinada câmara a partir de alguns planos tomográficos não caracteriza adequadamente a morfologia e a função de uma estrutura tridimensional (3D). Esse problema é ainda mais pronunciado no caso do ventrículo direito (VD): em comparação com o ventrículo esquerdo (VE) relativamente simples, em forma de bala, o VD possui uma geometria complexa2 que não pode ser adequadamente quantificada usando diâmetros lineares ou áreas3. Apesar desses fatos amplamente conhecidos, a morfologia e a função do VD geralmente são medidas por parâmetros tão simples na prática clínica.
Por muitas décadas, o RV foi considerado como tendo um papel muito menos importante na circulação em comparação com sua contraparte esquerda. Vários artigos de referência derrotaram esse ponto de vista, mostrando o forte papel prognóstico da geometria e função do VD em uma ampla variedade de doenças 4,5,6,7. Numerosos estudos demonstraram o valor incremental da medida do VD, mesmo usando parâmetros convencionais relativamente simples, o que destaca a importância e a necessidade de quantificação mais precisa da câmara com valor clínico potencialmente significativo.
A ecocardiografia 3D supera várias limitações da avaliação 2D das câmaras cardíacas. Embora a mensuração de volumes e também parâmetros funcionais livres de pressupostos geométricos possa ser de grande interesse também no caso do VE, ela pode ganhar particular importância na avaliação do VD8. Os volumes de VD derivados de 3D e a fração de ejeção (FE) apresentam valor prognóstico significativo em diversas condições cardiovasculares 9,10.
Atualmente, diversos fornecedores fornecem soluções semi-automatizadas para avaliação de RV 3D com resultados validados em relação às medidas de ressonância magnética cardíaca (RM) padrão-ouro11,12. Os requisitos técnicos da avaliação 3D são partes essenciais de um departamento de imagem cardiovascular de última geração hoje em dia, e espera-se que em breve faça parte do equipamento geral em todos os laboratórios de ecocardiografia. Com experiência adequada em aquisição 3D e pós-processamento, a análise 3D RV pode ser facilmente implementada no protocolo de exame padrão.

<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

Tradicionalmente, acreditava-se que o lado direito do coração tem um papel menor na circulação; no entanto, mais e mais dados sugerem que a função do ventrículo direito (VD) tem forte poder diagnóstico e prognóstico em vários distúrbios cardiovasculares. Devido à sua complexa morfologia e função, a avaliação do VD por ecocardiografia bidimensional convencional é limitada: a prática clínica cotidiana geralmente depende de dimensões lineares simples e medidas funcionais. A ecocardiografia tridimensional (3D) superou essas limitações, fornecendo quantificação volumétrica do VD livre de pressupostos geométricos. Aqui, oferecemos um guia passo-a-passo para obter e analisar dados ecocardiográficos 3D do VD usando o principal software comercialmente disponível. Vamos quantificar os volumes de RV 3D e a fração de ejeção. Vários aspectos técnicos podem ajudar a melhorar a qualidade da aquisição e análise de RV também, que apresentamos de forma prática. Revisamos as oportunidades atuais e os fatores limitantes desse método e também destacamos as potenciais aplicações da avaliação de RV 3D na prática clínica atual.

A análise 3D do VD é viável em uma ampla variedade de doenças cardiovasculares. O caso 1 é um voluntário saudável, com volumes e função ventricular normais (Figura 1). O caso 2 é um paciente pós-reparo da valva mitral que é um exemplo típico para os resultados conflitantes da avaliação 2D convencional: enquanto o TAPSE é acentuadamente reduzido, o paciente não apresenta sinais de disfunção do VD e uma função sistólica global do VD mantid...

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

Aqui, fornecemos um protocolo passo-a-passo de aquisição e análise para a avaliação volumétrica 3D do ventrículo direito, focando principalmente nos aspectos práticos que maximizam a viabilidade dessa técnica.

Avaliação Morfológica e Funcional do Ventrículo Direito Utilizando Ecocardiografia 3D

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 visualizações.  Semmelweis University Heart and Vascular Center. Aqui, fornecemos um protocolo passo-a-passo de aquisição e análise para a avaliação volumétrica 3D do ventrículo direito, focando principalmente nos aspectos práticos que maximizam a viabilidade dessa técnica.

Vídeo: 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.

Avaliação ecocardiográfica do coração direito em Ratos

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

Medicina

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.

Avaliação da Estrutura e Função do Ventrículo Direito em modelo de camundongo Pulmonary Artery constrição por Ecocardiografia transtorácica

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.

Abordagens ecocardiograma e protocolos de Comprehensive Caracterização fenotípica de doença cardíaca valvular em ratos

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.

Avaliação da Estrutura e Função Ventricular Esquerda utilizando Ecocardiografia 3D

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

Bioengenharia

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.

Método Ecocardiográfico Tridimensional para a Visualização e Avaliação de Parâmetros Específicos das Veias Pulmonares

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.

Mensuração ecocardiográfica dos parâmetros diastólicos do ventrículo direito no mouse

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.

Avaliação ecocardiográfica da anatomia e função cardíaca em ratos adultos

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.

Avaliação Biventricular da Função Cardíaca e Alças Pressão-Volume por Cateterismo Fechado de Tórax em Camundongos

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 ...

Remodelação 3D baseada em ICE para o átrio esquerdo e veia pulmonar

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.

Autor em destaque: Avanços na ecocardiografia intracardíaca para avaliação da anatomia atrial 

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.

Modelagem Tridimensional do Átrio Esquerdo e das Veias Pulmonares com Abordagem Precisa do Ecocardiograma Intracardíaco

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