Bu çalışma Macar Hükümeti Araştırma Fonu [GINOP-2.3.2-15-2016-00043, Szív- és érkutatási kiválóságközpont (IRONHEART)] tarafından finanse edildi.

Tüm hastalar yerel etik kurulun onayına göre muayeneden önce bilgilendirilmiş onay imzalatır (OGYÉI/12743/2018).
1. Hazırlık
<ol><li>Muayeneye hasta hazırlığı ile başlayın: en az 4 saatlik bir oruç durumunun sağlanması, yutma sorunları ve bilinen üst gastrointestinal hastalıklar hakkında anket.</li>
	<li>Yazılı bilgilendirilmiş onayın okunduğuna ve imzalandığından emin olun.</li>
	<li>Muayeneden önce damardan bir çizgi hazırlayın.</li>
	<li>Hastayı sol lateral decubitus pozisyonuna getirin.</li>
	<li>İntravenöz midazolam (2.5-5 mg) kullanarak hafif sedasyon uygular.</li>
	<li>EKG ve oksijen doygunluğunu izleyin.</li>
</ol>2. Görüntü alımı
<ol><li>Sol EV'lerin görselleştirilmesi<ol>
<li>Probu ön dişlerden yaklaşık 30-40 cm uzaklıkta özofagus içine yerleştirin.</li>
		<li>Üst (veya orta) transofagus prob konumunda, 20-45 ° 'de 2D görüntü alımını kullanarak LAA'yı görselleştirin.</li>
		<li>Laa'yı görüntüde merkezileştirmek için probu saat yönünde hafifçe çevirin ve kristal angülasyonunu 60-80° olarak değiştirin.</li>
		<li>Tam hacimli 3D alma uygulamak için tam ses düğmesini tıklatın.</li>
		<li>LAA ve sol üst PV'yi görüntülemek için görüntünün yanal ve yükseklik genişliğini ayarlayın. Bu, sol yanal sırtın görselleştirilmesini geliştirir.</li>
		<li>Görüntü kalitesini optimize edin (derinliği ve kazancı ayarlama, harmonik görüntüleme uygulama).</li>
		<li>2 kardiyak döngü ile tek vuruşlu (mümkünse çok atımlı) bir döngü kaydedin.</li>
		<li>LAA'yı merkezileştirmek için 2D görüntüde angülasyonu yaklaşık 120° olarak değiştirin.</li>
		<li>Sondayı saat yönünün tersine hafifçe çevirin ve sol PV'lerin ostiasını görselleştirmek için anteflexion uygulayın.</li>
		<li>Hem üst hem de alt TV'lerin görünür olduğunu doğrulamak için renkli Doppler kodlu görüntüleme uygulayın.</li>
		<li>Tam hacimli 3D alma uygulamak için tam ses düğmesini tıklatın.</li>
		<li>Sol TV'leri görüntülemek için görüntünün yanal ve yükseklik genişliğini ayarlayın. Bu, sol üst ve alt PV'lerin ostiasının ve araya giren sırtın görselleştirilmesini geliştirir.</li>
		<li>Veri kümesi kalitesini kontrol edin. Kaydedilen veri kümesini denetleyin. Veri kümesi hem üst hem de alt PV'leri içermiyorsa, yanal konuma daha fazla eğilerek hasta pozisyonunu değiştirin ve işlemi 2.1.8 adımından tekrarlayın.</li>
		<li>Sol TV'lerden 3D tam hacimli veri kümeleri alın: 2 kardiyak döngü ile tek vuruşlu (mümkünse çok canlı) döngü.</li>
		<li>Görüntüyü sırasıyla üst veya alt PV ostium'a kırparak PV ostia'nın görünürlüğünü onaylayın. Alt PV ostium özellikle dikkatli bir onay gerektirir. Ostiumun bazı bölümlerinin anatomik nedenlerden dolayı 3D veri kümesinin dışında olması, örneğin nirengi veya dönüştürücüye yakınlık.</li>
		<li>Görüntünün tüm BD yapısını görselleştirmek için uygun olmaması durumunda, 2.1.10 adımından itibaren yordamı tekrarlayın. Gerekirse, 3D veri kümesinin yanal veya yükseklik genişliğini değiştirin.</li>
	</ol>
</li>
	<li>Doğru EV'lerin görselleştirilmesi<ol>
<li>2B moda geri dönün ve görüntüyü 45° üst (veya orta) özofagus prob pozisyonunda LAA'ya odakla.</li>
		<li>Probu saat yönünde çevirin ve doğru PV'leri görselleştirmek için prob kafasını anteflexion konumuna getirin.</li>
		<li>Hem üst hem de alt TV'lerin görünür olduğunu doğrulamak için renkli Doppler kodlu görüntüleme uygulayın.</li>
		<li>Tam hacimli 3D alma uygulamak için tam ses düğmesini tıklatın.</li>
		<li>Sağ EV'leri görüntülemek için görüntünün yanal ve yükseklik genişliğini ayarlayın. Bu, sağ üst ve alt PV'lerin ostiasının ve araya giren sırtın görselleştirilmesini geliştirir. Bu görüntü, süper sayısal EV'lerin varlığını tanımlamak için kullanılabilir.</li>
		<li>Doğru CV'lerden 3D tam hacimli veri kümeleri alın: 2 kardiyak döngü ile tek vuruşlu (mümkünse çok canlı) döngü.</li>
		<li>Görüntüyü sırasıyla üst veya alt PV ostium'a kırparak PV ostia'nın görünürlüğünü onaylayın. Alt PV ostium özellikle dikkatli bir onay gerektirir. Ostiumun bazı bölümlerinin anatomik nedenlerle (örneğin, angülasyon veya dönüştürücüye yakınlık) 3D veri kümesinin dışında olması olağandışı değildir.</li>
		<li>Veri kümesi hem üst hem de alt PV'leri içermiyorsa, hasta pozisyonu doğru konuma daha fazla eğilerek değiştirilmeli ve prosedür 2.2.1 adımından itibaren tekrarlanmalıdır. Gerekirse, 3D veri kümesinin yanal veya yükseklik genişliğini değiştirin.</li>
	</ol>
</li>
</ol>3.3D görüntü rekonstrüksiyonu ve ölçümleri
<ol><li>Çevrimdışı 3D çokplanar rekonstrüksiyon<ol>
<li>Tarayıcınızda veya iş istasyonunuzda 3D analiz yazılımını etkinleştirin (Philips: QApps panelinde 3DQ yazılımını etkinleştirin; Tomtec: 4D Kardiyo manzaralı 3 uygulamasını etkinleştirin; GE: FlexiSlice yazılımını etkinleştirin).</li>
		<li>Ölçümler için diyastolik fazda bir çerçeve seçin. Standardizasyon için, T dalgasına zamanlanmış bir çerçeve seçmeniz önerilir.</li>
		<li>İki dik düzlemi istenen yapıya (sol yanal sırt veya her PVs ostium) ayarlayın ve 3. düzlem incelenen yapının en yüz görünümünü temsil ederken düzlem yönünü ayarlayın.</li>
		<li>Sol panelde ölçüm seçeneğini belirleyin. En yüz görünümü ölçümler için uygundur (çap, alan, mesafe).</li>
	</ol>
</li>
</ol>

<ol>
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A., Ho, S. Y., Climent, V., Sanchez-Quintana, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+architecture+of+the+left+lateral+atrial+wall:+a+particular+anatomic+region+with+implications+for+ablation+of+atrial+fibrillation.">The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation.</a> European Heart Journal. 29 (3), 356-362 (2008).</li><li>Kubala, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+pulmonary+veins+anatomy+is+associated+with+better+AF-free+survival+after+cryoablation+as+compared+to+atypical+anatomy+with+common+left+pulmonary+vein.">Normal pulmonary veins anatomy is associated with better AF-free survival after cryoablation as compared to atypical anatomy with common left pulmonary vein.</a> Pacing and Clinical Electrophysiology. 34 (7), 837-843 (2011).</li><li>Guler, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Pulmonary+Vein+Anatomy+and+Pulmonary+Vein+Diameters+on+Outcome+of+Cryoballoon+Catheter+Ablation+for+Atrial+Fibrillation.">Effect of Pulmonary Vein Anatomy and Pulmonary Vein Diameters on Outcome of Cryoballoon Catheter Ablation for Atrial Fibrillation.</a> Pacing and Clinical Electrophysiology. 38 (8), 989-996 (2015).</li><li>Baran, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+pulmonary+vein+ostia+anatomy+on+efficacy+of+cryoballoon+ablation+for+atrial+fibrillation.">Impact of pulmonary vein ostia anatomy on efficacy of cryoballoon ablation for atrial fibrillation.</a> Heart Beat Journal. 1, 65-70 (2017).</li><li>Sorgente, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+vein+ostium+shape+and+orientation+as+possible+predictors+of+occlusion+in+patients+with+drug-refractory+paroxysmal+atrial+fibrillation+undergoing+cryoballoon+ablation.">Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation.</a> Europace. 13 (2), 205-212 (2011).</li><li>Chun, K. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+'single+big+cryoballoon'+technique+for+acute+pulmonary+vein+isolation+in+patients+with+paroxysmal+atrial+fibrillation:+a+prospective+observational+single+centre+study.">The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study.</a> European Heart Journal. 30 (6), 699-709 (2009).</li><li>Cabrera, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morphological+evidence+of+muscular+connections+between+contiguous+pulmonary+venous+orifices:+relevance+of+the+interpulmonary+isthmus+for+catheter+ablation+in+atrial+fibrillation.">Morphological evidence of muscular connections between contiguous pulmonary venous orifices: relevance of the interpulmonary isthmus for catheter ablation in atrial fibrillation.</a> Heart Rhythm. 6 (8), 1192-1198 (2009).</li><li>McLellan, A. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+vein+isolation:+the+impact+of+pulmonary+venous+anatomy+on+long-term+outcome+of+catheter+ablation+for+paroxysmal+atrial+fibrillation.">Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation.</a> Heart Rhythm. 11 (4), 549-556 (2014).</li><li>Mansour, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+anatomy+of+the+left+atrium+by+magnetic+resonance+angiography:+implications+for+catheter+ablation+for+atrial+fibrillation.">Three-dimensional anatomy of the left atrium by magnetic resonance angiography: implications for catheter ablation for atrial fibrillation.</a> Journal of Cardiovascular Electrophysiology. 17 (7), 719-723 (2006).</li><li>Ottaviano, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryoballoon+ablation+for+atrial+fibrillation+guided+by+real-time+three-dimensional+transoesophageal+echocardiography:+a+feasibility+study.">Cryoballoon ablation for atrial fibrillation guided by real-time three-dimensional transoesophageal echocardiography: a feasibility study.</a> Europace. 15 (7), 944-950 (2013).</li><li>Faletra, F. 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Yazarlar çıkar çatışması olmadığını bildiriyor.

Burada, 3D ekokardiyografi ile PV'leri, çevre yapılarını ve anatomik özelliklerini incelemek için adım adım bir metodoloji gösteriyoruz. PV'lerin 3D görüntülenmesi için yukarıda açıklanan yöntem, hassas ölçümler için uygun çoğu hastada yüksek kaliteli 3D görüntüler sağlayan kolayca standartleştirilebilir bir yöntemdir. Elde edilen görüntülerin optimal kalitesi ve yönü, PV anatomisinin uygun şekilde değerlendirilmesi için çok önemlidir. 3B yeniden yapılandırılmış görüntüler,...

Pulmoner damarların (PV) drenaj paterni, ortalama popülasyonda %56,5'lik değişim ile oldukça değişkendir1. Günümüzde atriyal fibrilasyonun en yaygın girişimsel tedavisi olan PV izolasyonu (PVI) planlarken PV drenaj patizörünün değerlendirilmesi çok önemlidir2,3,4. Radyofrekans kateter ablasyonu PVI'ye ulaşmak için standart teknoloji olmasına rağmen, kriyoballoon (CB) tabanlı ablasyon teknolojisi (CA) daha az prosedürel zaman gerektiren alternatif bir yöntemdir. Teknik radyofrekans ablasyon5,6 ile karşılaştırıldığında daha az karmaşıktır, CA'nın etkinliği ve güvenliği radyofrekans ablasyon7 olanlara benzer.
CB tarafından prosedürel PV tıkanıklığı oranı ve PV ostiumunda doku hasarının sürekli çevresel olarak uzatılması, PVI'nin CA'dan sonra kalıcı başarısını belirler. PV tıkanıklığının ana belirleyicilerinden biri PV anatomisinin varyasyonudur. Son zamanlarda bilgisayarlı tomografi- (BT) ve kardiyak MRG tabanlı çalışmalarda, CA'yı takiben kısa ve uzun vadeli başarı oranlarının tahmin değerleri ile çeşitli PV parametreleri tanımlanmıştır. Bu parametreler hem PV anatomisinin (sol ortak PV, süper sayısal PVs8,9,10, ostial alan, ovallik indeksi8,11,12,13) hem de çevresinin (müdahaleci sırt8,14,15,16, sol lateral sırt kalınlığı8,9,17) varyasyonlarını içeriyordu.
Geleneksel 2D ekokardiyografi yukarıdaki parametrelerin çoğunu görüntülemek ve ölçmek için uygun olmasa da, üç boyutlu transözofageal ekokardiyografi (3D TEE), önceki literatür verilerinde gösterildiği gibi PV'leri görselleştirmek için alternatif bir araç gibi görünmektedir18,19.
Ayrıca, PVI'den önceki 3D TEE, sadece prosedürel tasarım için PV özellikleri hakkında veri sağlamakla kalmaz, aynı zamanda sol atriyal ekte (LAA) bir trombüs olup olmadığını da netleştirir. Bu soruşturma özellikle PVI'den önce önemlidir. Aynı zamanda, 3D TEE daha az zaman gerektirir, prosedür maliyeti düşüktür ve hastayı ve tıbbi personeli radyasyona maruz bırakmaz.
Geçmişte, farklı boyutlarda çeşitli CB türleri mevcuttu, bu da PV'lerin çeşitli parametrelerinin CA'nın başarı oranını nasıl etkilediğini tahmin etmeyi zorlaştırdı. Bugün, yeni tanıtılan ikinci nesil CB, yalnızca bir boyutta bulunan CA için kullanılmaktadır. Geliştirilmiş soğutma etkisi sayesinde, ikinci nesil CB, PVI'den önce PV anatomisi ve girişimsel planlamanın önemini daha da vurgulayan birinci nesil CB20'ye kıyasla çok daha yüksek bir performans sunar.

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

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

Pulmoner venlerin boyutları, özellikle kriyoballoon ablasyon tekniği ile pulmoner ven izolasyonu (PVI) planlarken önemli parametrelerdir. Pulmoner damarların (PV) boyutlarını ve anatomik varyasyonlarını kabul etmek müdahalenin sonucunu iyileştirebilir. Geleneksel 2D transofagus ekokardiyografisi sadece PV'lerin boyutları hakkında sınırlı veri sağlayabilir; bununla birlikte, 3D ekokardiyografi, PV'lerin ilgili çaplarını ve alanlarını ve çevredeki yapılarla mekansal ilişkilerini daha fazla değerlendirebilir. Önceki literatür verilerinde, PVI'nin başarı oranını etkileyen parametreler zaten tanımlanmıştır. Bunlar sol yanal sırt, müdahale eden sırt, PV'lerin ostial alanı ve ostiumun ovallik indeksi. PV'lerin 3D ekokardiyografi ile uygun şekilde görüntülenmesi teknik olarak zorlayıcı bir yöntemdir. Önemli bir adım, görüntülerin toplanmasıdır. Önemli yapıları görselleştirmek için üç ayrı dönüştürücü pozisyon gereklidir; bunlar sol yanal sırt, PV'lerin ostium ve sol ve sağ PV'lerin müdahaleli sırtıdır. Daha sonra, 3D görüntüler elde edilir ve dijital döngüler olarak kaydedilir. Bu veri kümeleri kırpılır ve bu da en face görünümlerinin uzamsal ilişkileri görüntülemesi ile sonuçlanır. Bu adım, PV'lerin anatomik varyasyonlarını belirlemek için de kullanılabilir. Son olarak, PV'lerin her bir parametresini ölçmek için çok düzlemsel rekonstrüksiyonlar oluşturulur.
Elde edilen görüntülerin optimal kalitesi ve yönü, PV anatomisinin uygun şekilde değerlendirilmesi için çok önemlidir. Bu çalışmada 80 hastada PV'lerin 3D görünürlüğünü ve yukarıdaki yöntemin uygunluğunu inceledik. Amaç, 3D ekokardiyografi ile PV görselleştirme ve değerlendirmesinin temel adımlarının ve potansiyel tuzaklarının ayrıntılı bir özetini sağlamaktı.

Yukarıda açıklanan görüntü alma protokolünü kullanarak, ilk adım sol atriyal uzantıyı (LAA) 2D alma kullanarak görselleştirmektir (Şekil 1). Prob 20-45° seviyesinde üst (veya orta) transofagus pozisyonundadır. GörüntüDE LAA görülüyor. Sol yanal sırt ve sol üst PV 60-80° olarak görüntülenir (Şekil 2) ve daha sonra LAA ve sol yanal sırtı sol üst PV ostium ile görselleştirmek için veri kümesi kırpılarak 3D veri kümesi elde ed...

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

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

Pulmoner ven izolasyonu planlanırken pulmoner damarların (PV) boyutları önemli parametrelerdir. 2D transofagus ekokardiyografisi sadece PV'ler hakkında sınırlı veri sağlayabilir; bununla birlikte, 3D ekokardiyografi, PV'lerin ilgili çaplarını ve alanlarını ve çevredeki yapılarla mekansal ilişkilerini değerlendirebilir.

Pulmoner Damarların Spesifik Parametrelerinin Görselleştirilmesi ve Değerlendirilmesi için Üç Boyutlu Ekokardiyografik Yöntem

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

three-dimensional-echocardiographic-method-for-visualization

Research

JoVE Journal

Bioengineering

2.7K Görüntüleme.  University of Debrecen. Pulmoner ven izolasyonu planlanırken pulmoner damarların (PV) boyutları önemli parametrelerdir. 2D transofagus ekokardiyografisi sadece PV'ler hakkında sınırlı veri sağlayabilir; bununla birlikte, 3D ekokardiyografi, PV'lerin ilgili çaplarını ve alanlarını ve çevredeki yapılarla mekansal ilişkilerini değerlendirebilir.

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

Transthoracic Echocardiography in Mice

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

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

Fareler de Transtorasik Ekokardiyografi

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

Tıp

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.

Transtorasik Ekokardiyografi ile Pulmoner Arter Konstrüksiyon Fare Modeli sağ ventrikül yapı ve fonksiyonlarının değerlendirilmesi

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.

Farelerde Kalp Kapak Hastalıkları Kapsamlı Fenotipik Karakterizasyonu için ekokardiyografik Yaklaşımlar ve Protokoller

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 ...

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.

Sol Atrium, Aort ve Pulmoner Arter Murin Ekokardiyografi

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

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Three-dimensional (3D) quantification of the left ventricle (LV) provides significant added value in terms of diagnostic accuracy and precise risk stratification in various cardiac disorders. Recently, 3D echocardiography became available in routine cardiology practice; however, high-quality image acquisition and subsequent analysis have a steep learning curve. The present article aims to guide the reader through a detailed 3D protocol by presenting tips and tricks and also by highlighting the potential pitfalls to facilitate the widespread but technically sound use of this important technique concerning the LV. First and foremost, we show the acquisition of a high-quality 3D dataset with optimal spatial and temporal resolution. Then, we present the analytical steps toward a detailed quantification of the LV by using one of the most widely applied built-in software. We will quantify LV volumes, sphericity, mass and also systolic function by measuring ejection fraction and myocardial deformation (longitudinal and circumferential strain). We will discuss and provide clinical examples about the essential scenarios where the transition from a conventional echocardiographic approach to a 3D-based quantification is highly recommended.

In this article, we provide a step-by-step acquisition and analysis protocol for the volumetric assessment and speckle-tracking analysis of the left ventricle by 3D echocardiography, particularly focusing on practical aspects that maximize the feasibility of this technique.

3D Ekokardiyografi Kullanılarak Sol Ventrikül Yapısı ve İşlevinin Değerlendirilmesi

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

Biyomühendislik

Transthoracic Echocardiographic Examination in the Rabbit Model

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

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

Tavşan modelinde transtortik ekokardiyografi sınavı

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

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

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

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

3D Ekokardiyografi ile Sağ Ventrikülün Morfolojik ve Fonksiyonel Değerlendirmesi

Traditionally, it was believed that the right side of the heart has a minor role in circulation; however, more and more data suggest that right ...

The Use of 3D Echocardiography in Surgical Planning of the Mitral Valve in Pediatric Cardiology

Mitral valve disease in pediatric cardiology is complex and can involve a combination of annular, leaflet, chordae tendineae and papillary muscle abnormalities. Transthoracic two-dimensional echocardiography (2DE) remains the primary diagnostic imaging technique utilized in pediatric surgical planning. However, given that the mitral valve is a three-dimensional (3D) structure, the addition of 3D echocardiography (3DE) to better define the mechanisms of stenosis and/or regurgitation is advantageous. Transthoracic 3DE technology has improved with advances in probe technology and ultrasound scanners, producing images with good spatial resolution and adequate temporal resolution. Specifically, the addition of pediatric 3D transducers with higher frequencies and a smaller footprint provides better 3DE imaging in children. Improved efficiency of 3DE acquisition and analysis allow 3D assessment of the mitral valve to be more easily integrated by the sonographer, the cardiologist and the surgeon in mitral valve assessment. This improvement was also made possible by the postprocessing software optimization.
In this method paper, we aim to describe the transthoracic 3DE assessment of the mitral valve in children and its use in the surgical planning of pediatric mitral valve disease. Firstly, the 3DE assessment begins by selecting the correct probe and by obtaining a view of the mitral valve. Then, the appropriate data acquisition method should be selected based on the individual patient. Next, optimization of the data set is critical in order to properly balance spatial and temporal resolution. During live scanning or following acquisition, the data set can be cropped using innovative tools that allow the user to quickly obtain an infinite number of cut planes or volumetric reconstructions. The cardiologist and surgeon can view the mitral valve en face; thus, accurately reconstructing its morphology in order to support medical or surgical planning. Finally, a review of some clinical applications is proposed, showing examples in pediatric mitral valve managements.

3D echocardiography of the mitral valve in pediatric cardiology produces full anatomic reconstructions that contribute to improved surgical management. Here, we outline a protocol for 3D acquisition and post-processing of the mitral valve in pediatric cardiology.

Mitral valve disease in pediatric cardiology is complex and can involve a combination of annular, leaflet, chordae tendineae and papillary muscle ...

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

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

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

Transkateter Pulmoner Kapak Replasmanı için Dört Boyutlu Bilgisayarlı Tomografi Kılavuzluğunda Kapak Boyutlandırma

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

Sol Atriyum ve Pulmoner Ven için ICE Tabanlı 3D Yeniden Modelleme

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.

Yazar Spotlight: Atriyal Anatomi Değerlendirmesi için İntrakardiyak Ekokardiyografideki Gelişmeler 

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.

Sol Atriyum ve Pulmoner Venlerin Hassas İntrakardiyak Ekokardiyografi Yaklaşımı ile Üç Boyutlu Modellenmesi

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