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

Dette arbejde blev finansieret af den ungarske regerings forskningsfond [GINOP-2.3.2-15-2016-00043, Szív- és érkutatási kiválóságközpont (IRONHEART)].

Alle patienter underskrev informeret samtykke før undersøgelse efter godkendelse fra det lokale etiske udvalg (OGYÉI/12743/2018).
1. Forberedelse
<ol><li>Start undersøgelsen med patientforberedelse: sikring af mindst 4-timers fastestatus, spørgeskema om problemer med synke og kendte øvre gastrointestinale sygdomme.</li>
	<li>Sørg for, at skriftligt informeret samtykke læses og underskrives.</li>
	<li>Forbered en intravenøs linje før undersøgelsen.</li>
	<li>Placer patienten i en v...

<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>

Her demonstrerer vi en trinvis metode til at studere PVs, deres omgivende strukturer og anatomiske egenskaber med 3D ekkokardiografi. Ovennævnte metode til 3D-billeddannelse af PVs er en let standardiseret metode, som giver høj kvalitet 3D-billeder hos de fleste patienter egnet til præcise målinger. Optimal kvalitet og orientering af de erhvervede billeder er afgørende for en passende vurdering af PV anatomi. 3D rekonstruerede billeder forbedrer visualiseringen af PV dræning mønster og dens anatomiske variabilitet...

Dræning mønster af lunge vener (PV) er meget varierende med 56,5% variation i den gennemsnitlige befolkning1. Evaluering af PV dræning mønster er afgørende ved planlægningen PV isolation (PVI), som er den mest almindelige interventionelle behandling af atrieflimren i dag2,3,4. Selv om radiofrekvenskateterablation har været standardteknologien til at opnå PVI, er den kryoballoon (CB)-baserede ablationsteknologi (CA) en alternativ metode, der kræver mindre proceduremæssig tid. Teknikken er mindre kompliceret sammenlignet med radiofrekvens ablation5,6, mens effekten og sikkerheden af CA svarer til den radiofrekvens ablation7.
Hyppigheden af proceduremæssige PV okklusion af CB og den fortsatte omskæringsret forlængelse af vævsskade i PV ostium bestemmer den permanente succes PVI efter CA. En af de vigtigste determinanter for PV okklusion er variationen af PV anatomi. I de seneste, computertomografi- (CT) og hjerte MRI-baserede undersøgelser, flere PV parametre blev identificeret med prædiktive værdier af korte og langsigtede succesrater efter CA. Disse parametre omfattede variationer af både PV anatomi (venstre fælles PV, overtallige PVs8,9,10, ostial område, ovalitet index8,11,12,13) og dens omgivelser (mellemliggende ridge8,14,15,16, tykkelse af venstre lateral ridge8,9,17).
Selvom konventionel 2D-ekkokardiografi ikke er egnet til visning og måling af de fleste af ovenstående parametre, synes tredimensionel transesophageal ekkokardiografi (3D TEE) at være et alternativt værktøj til at visualisere PVs, som det fremgår af tidligere litteraturdata18,19.
Desuden giver 3D TEE forud for PVI yderligere værdi i forhold til CT eller MRI, da det ikke kun indeholder data om PV-egenskaber til proceduremæssig design, men også præciserer, om en trombe i venstre atrie vedhæng (LAA) er til stede. Denne undersøgelse er særlig vigtig forud for PVI. Samtidig kræver 3D TEE mindre tid, dens proceduremæssige omkostninger er lave, og det udsætter ikke patienten og det medicinske personale for stråling.
Tidligere eksisterede der flere typer certificeringsorganer med forskellige størrelser, hvilket gjorde det vanskeligt at ekstrapolere, hvordan de forskellige parametre for PVs påvirker ca'ens succesrate. I dag bruges den nyligt introducerede andengenerations CB til CA, som kun findes i én størrelse. Takket være den forbedrede køleeffekt tilbyder andengenerations CB en meget højere ydeevne sammenlignet med første generation af CB20, hvilket yderligere fremhæver vigtigheden af PV anatomi og interventionel planlægning før PVI.

<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

Dimensionerne af lungeårerne er vigtige parametre, når man planlægger lungeveisolation (PVI), især med kryoballoonablationsteknikken. Erkendelse af dimensionerne og anatomiske variationer af lungeårerne (PVs) kan forbedre resultatet af interventionen. Konventionel 2D-transoesofageal ekkokardiografi kan kun give begrænsede data om PV'ernes dimensioner; 3D-ekkokardiografi kan dog yderligere evaluere relevante diametre og områder af PVs samt deres rumlige forhold til de omkringliggende strukturer. I tidligere litteraturdata er parametre, der påvirker PVI's succesrate, allerede blevet identificeret. Disse er den venstre laterale højderyg, den mellemliggende højderyg, PVs'ernes ostialområde og ostiumets ovalitetsindeks. Korrekt billeddannelse af PVs ved 3D ekkokardiografi er en teknisk udfordrende metode. Et afgørende skridt er samlingen af billeder. Tre individuelle transducerpositioner er nødvendige for at visualisere de vigtige strukturer; disse er den venstre laterale højderyg, pvsens ostium og den mellemliggende højderyg af venstre og højre PVs. Dernæst erhverves og gemmes 3D-billeder som digitale sløjfer. Disse datasæt beskæres, hvilket resulterer i, at en face-visningerne viser rumlige relationer. Dette trin kan også anvendes til at bestemme de anatomiske variationer af PVs. Endelig oprettes multiplanarrekonstruktioner for at måle hver enkelt parameter for PVs.
Optimal kvalitet og orientering af de erhvervede billeder er afgørende for en passende vurdering af PV anatomi. I dette arbejde undersøgte vi PV'ernes 3D-synlighed og egnetheden af ovenstående metode hos 80 patienter. Målet var at give en detaljeret oversigt over de væsentlige skridt og potentielle faldgruber ved PV visualisering og vurdering med 3D ekkokardiografi.

Ved hjælp af den ovenfor beskrevne billedopsamlingsprotokol er det første skridt at visualisere det venstre atrievedhæng (LAA) ved hjælp af 2D-erhvervelse (Figur 1). Sonden er i den øvre (eller midterste) transoesofageale position ved 20-45°. Billedet viser LAA. Den venstre sideryg og venstre øvre PV vises ved 60-80° (figur 2), og derefter erhverves og bekræftes 3D-datasættet ved at beskære datasættet for at visualisere LAA og venstre sideryg med ven...

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

Dimensionerne af lungeårerne (PV) er vigtige parametre, når man planlægger lungeåreisolering. 2D transoesofageal ekkokardiografi kan kun give begrænsede data om PVs; 3D-ekkokardiografi kan dog evaluere relevante diametre og områder af PVs samt deres rumlige forhold til de omkringliggende strukturer.

Tredimensionel ekkokardiografisk metode til visualisering og vurdering af specifikke parametre for lungeårerne

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

Research

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