Name: three-dimensional echocardiographic method for the visualization and assessment of specific parameters of the pulmonary veins
Uploaded: 2020-10-28T14:00:00
Description: 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

这项工作由匈牙利政府研究基金[GINOP-2.3.2-15-2016-00043，Szív-és érkutatási kiválóságközpont（IRONHEART）]资助。

所有患者在检查前根据当地伦理委员会的批准（OGYÉI/12743/2018）签署了知情同意书。
1. 准备工作
<ol><li>从患者准备开始检查：确保至少4小时的禁食状态，关于吞咽问题和已知上消化道疾病的问卷调查。</li>
	<li>确保阅读并签署书面知情同意书。</li>
	<li>检查前准备静脉注射管路。</li>
	<li>将患者置于左外侧卧位。</li>
	<li>使用静脉注射咪达唑仑（2.5-5mg）给予轻度镇静剂。</li>
...

<ol>
	<li>Altinkaynak, D., Koktener, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+pulmonary+venous+variations+in+a+large+cohort:+Multidetector+computed+tomography+study+with+new+variations.">Evaluation of pulmonary venous variations in a large cohort: Multidetector computed tomography study with new variations.</a> Wiener klinische Wochenschrift. 131 (19-20), 475-484 (2019).</li><li>Haissaguerre, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spontaneous+initiation+of+atrial+fibrillation+by+ectopic+beats+originating+in+the+pulmonary+veins.">Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.</a> New England Journal of Medicine. 339 (10), 659-666 (1998).</li><li>Nault, I., 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=Drugs+vs.+ablation+for+the+treatment+of+atrial+fibrillation:+the+evidence+supporting+catheter+ablation.">Drugs vs. ablation for the treatment of atrial fibrillation: the evidence supporting catheter ablation.</a> European Heart Journal. 31 (9), 1046-1054 (2010).</li><li>Calkins, H., 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=HRS/EHRA/ECAS+expert+consensus+statement+on+catheter+and+surgical+ablation+of+atrial+fibrillation:+recommendations+for+patient+selection,+procedural+techniques,+patient+management+and+follow-up,+definitions,+endpoints,+and+research+trial+design:+a+report+of+the+Heart+Rhythm+Society+(HRS)+Task+Force+on+Catheter+and+Surgical+Ablation+of+Atrial+Fibrillation.">HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation.</a> Heart Rhythm. 9 (4), 632-696 (2012).</li><li>Kojodjojo, P., 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+venous+isolation+by+antral+ablation+with+a+large+cryoballoon+for+treatment+of+paroxysmal+and+persistent+atrial+fibrillation:+medium-term+outcomes+and+non-randomised+comparison+with+pulmonary+venous+isolation+by+radiofrequency+ablation.">Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and non-randomised comparison with pulmonary venous isolation by radiofrequency ablation.</a> Heart. 96 (17), 1379-1384 (2010).</li><li>Packer, D. 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+of+pulmonary+veins+for+paroxysmal+atrial+fibrillation:+first+results+of+the+North+American+Arctic+Front+(STOP+AF)+pivotal+trial.">Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial.</a> Journal of the American College of Cardiology. 61 (16), 1713-1723 (2013).</li><li>Kuck, K., Brugada, J., Albenque, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryoballoon+or+Radiofrequency+Ablation+for+Atrial+Fibrillation.">Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation.</a> New England Journal of Medicine. 375 (11), 1100-1101 (2016).</li><li>Knecht, S., 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=Anatomical+predictors+for+acute+and+mid-term+success+of+cryoballoon+ablation+of+atrial+fibrillation+using+the+28+mm+balloon.">Anatomical predictors for acute and mid-term success of cryoballoon ablation of atrial fibrillation using the 28 mm balloon.</a> Journal of Cardiovascular Electrophysiology. 24 (2), 132-138 (2013).</li><li>Cabrera, J. 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. F., Regoli, F., Acena, M., Auricchio, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Value+of+real-time+transesophageal+3-dimensional+echocardiography+in+guiding+ablation+of+isthmus-dependent+atrial+flutter+and+pulmonary+vein+isolation.">Value of real-time transesophageal 3-dimensional echocardiography in guiding ablation of isthmus-dependent atrial flutter and pulmonary vein isolation.</a> Circulation Journal. 76 (1), 5-14 (2012).</li><li>Coulombe, N., Paulin, J., Su, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improved+in+vivo+performance+of+second-generation+cryoballoon+for+pulmonary+vein+isolation.">Improved in vivo performance of second-generation cryoballoon for pulmonary vein isolation.</a> Journal of Cardiovascular Electrophysiology. 24 (8), 919-925 (2013).</li></ol>

在这里，我们展示了一种分步方法，通过3D超声心动图研究PV，其周围结构和解剖学特征。上述用于PV的3D成像方法是一种易于标准化的方法，它为大多数患者提供了适合精确测量的高质量3D图像。所采集图像的最佳质量和方向对于PV解剖结构的适当评估至关重要。3D重建图像增强了PV引流模式的可视化及其解剖变异性，这可能会影响PVI与CA的成功率。
PV的3D成像克服了传统2D经食?...

肺静脉 （PV） 的引流模式变化很大，平均人群变异率为 56.5%1。在规划 PV 隔离 （PVI） 时，评估 PV 引流模式至关重要，这是目前最常见的心房颤动介入治疗2，3，4。虽然射频导管消融术一直是实现PVI的标准技术，但基于冷冻球囊（CB）的消融技术（CA）是一种需要较少手术时间的替代方法。与射频消融相比，该技术不那么复杂5，6，而CA的功效和安全性与射频消融相似7。
CB的程序性PV闭塞率和PV口组织损伤的连续环向延伸决定了CA后PVI的永久成功。PV闭塞的主要决定因素之一是PV解剖结构的变化。在最近的基于计算机断层扫描（CT）和心脏MRI的研究中，确定了几个PV参数，并具有CA后短期和长期成功率的预测值。这些参数包括PV解剖结构（左侧普通PV，多余的PV8，9，10，骨面积，椭圆度指数8，11，12，13）及其周围环境（中间脊8，14，15，16，左侧脊的厚度8，9，17）的变化。
虽然传统的2D超声心动图不适合显示和测量上述大部分参数，但三维经食管超声心动图（3D TEE）似乎是可视化PV的替代工具，如先前的文献数据所示18，19。
此外，与CT或MRI相比，PVI之前的3D TEE具有额外的价值，因为它不仅为程序设计提供了PV特性的数据，而且还澄清了左心耳（LAA）中是否存在血栓。在PVI之前，这项调查尤其重要。同时，3D TEE需要的时间更少，其程序成本低，并且不会使患者和医务人员暴露于辐射。
过去，存在几种类型的不同大小的CB，这使得很难推断PV的各种参数如何影响CA的成功率。今天，新推出的第二代CB用于CA，CA仅以一种尺寸存在。由于其改进的冷却效果，与第一代CB20相比，第二代CB提供了更高的性能，这进一步凸显了PV解剖学和PVI之前介入计划的重要性。

<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>
	</tbody>
</table>

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

在计划肺静脉分离 （PVI） 时，肺静脉的尺寸是重要参数，尤其是使用冷冻球囊消融技术时。承认肺静脉（PVs）的尺寸和解剖学变化可能会改善干预的结果。常规的2D经食管超声心动图只能提供有关PV尺寸的有限数据;然而，3D超声心动图可以进一步评估PV的相关直径和区域，以及它们与周围结构的空间关系。在以往的文献数据中，已经确定了影响PVI成功率的参数。这些是左侧脊，中间脊，PV的骨面积和骨的椭圆指数。通过3D超声心动图对PV进行适当的成像是一种技术上具有挑战性的方法。一个关键步骤是收集图像。需要三个单独的传感器位置来可视化重要结构;这些是左侧脊，PV的骨脊以及左右PV的中间脊。接下来，采集3D图像并将其保存为数字循环。这些数据集将被裁剪，这将导致 en 人脸视图显示空间关系。该步骤也可用于确定PV的解剖学变化。最后，创建多平面重建以测量PV的每个单独参数。
所采集图像的最佳质量和方向对于PV解剖结构的适当评估至关重要。在目前的工作中，我们检查了PV的3D可见性以及上述方法在80名患者的适用性。目的是提供光伏可视化和评估3D超声心动图的基本步骤和潜在陷阱的详细概述。

使用上述图像采集方案，第一步是使用2D采集可视化左心耳（LAA）（图1）。探头位于经食管上部（或中部）20-45°。该图显示了 LAA。左侧脊和左上侧PV以60-80°显示（图2），然后通过裁剪数据集获取并确认3D数据集，以便可视化LAA和左上部PV口的左侧脊（图3）。如果数据集不包含LAA和左侧脊的整个结构，则在改变探针角度，屈曲或?...

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

肺静脉 （PV） 的尺寸是计划肺静脉分离时的重要参数。2D经食管超声心动图只能提供有关PV的有限数据;然而，3D超声心动图可以评估PV的相关直径和区域，以及它们与周围结构的空间关系。

用于肺静脉特定参数可视化和评估的三维超声心动图方法

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

Research

JoVE Journal

Bioengineering

Alginate Hydrogels for Three-Dimensional Organ Culture of Ovaries and Oviducts

卵巢和输卵管的三维器官培养的海藻酸钙凝胶

Ovarian cancer is the fifth leading cause of cancer deaths in women and has a 63% mortality rate in the United States1. The cell type of origin for ...

科研

生物工程

The Three-Dimensional Human Skin Reconstruct Model: a Tool to Study Normal  Skin and Melanoma Progression

三维人体皮肤重建模型：一种工具来研究正常皮肤恶性黑色素瘤进展

Most in vitro studies in experimental skin biology have been done in 2-dimensional (2D) monocultures, while accumulating evidence suggests that cells ...

Planar and Three-Dimensional Printing of Conductive Inks

平面和立体印刷的导电油墨

Printed electronics rely on low-cost, large-area fabrication routes to create flexible or multidimensional electronic, optoelectronic, and biomedical ...

Three-dimensional Cell Culture Model for Measuring the Effects of Interstitial Fluid Flow on Tumor Cell Invasion

三维细胞培养模式的测量肿瘤细胞浸润间质流体流动的影响

The growth and progression of most solid tumors depend on the initial transformation of the cancer cells and their response to stroma-associated signaling ...

Patient-specific Modeling of the Heart: Estimation of Ventricular Fiber Orientations

病人的具体建模之心：的心室纤维方向估计

Patient-specific  simulations of heart (dys)function aimed at personalizing cardiac therapy are hampered  by the absence of in vivo imaging technology for ...

Investigating the Three-dimensional Flow Separation Induced by a Model Vocal Fold Polyp

研究模型声乐折叠聚合物引起的三维流量分离

The fluid-structure energy exchange process for normal speech has been studied extensively, but it is not well understood for pathological conditions. ...

Human Cartilage Tissue Fabrication Using Three-dimensional Inkjet Printing Technology

人体软骨组织制作采用三维喷墨打印技术

Bioprinting, which is based on thermal inkjet printing, is one of the most attractive enabling technologies in the field of tissue engineering and ...

Analysis of Cell Migration within a Three-dimensional Collagen Matrix

在一个三维胶原蛋白矩阵分析细胞迁移

The ability to migrate is a hallmark of various cell types and plays a crucial role in several physiological processes, including&#160;embryonic ...

Generation of a Three-dimensional Full Thickness Skin Equivalent and Automated Wounding

三维全层皮肤的生成等效和自动伤人

In vitro models are a cost effective and ethical alternative to study cutaneous wound healing processes. Moreover, by using human cells, these models ...

Studying Protein Function and the Role of Altered Protein Expression by Antibody Interference and Three-dimensional Reconstructions

研究蛋白质功能和改变的蛋白的表达由源抗体干扰和三维重建中的作用

A strict management of protein expression is not only essential to every organism alive, but also an important strategy to investigate protein functions ...