Name: echocardiographic evaluation of atrial communications before transcatheter closure
Uploaded: 2022-02-08T13:00:00
Description: Watch this Scientific Journal Video about Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure at JoVE.com

项目编号NVKP 16-1-2016-0017（"国家心脏计划"）已在匈牙利国家研究，发展和创新基金的支持下实施，该基金由NVKP 16资助计划资助。该研究由匈牙利创新和技术部的主题卓越计划（2020-4.1.1.-TKP2020）资助，在塞梅尔威斯大学的治疗开发和生物成像主题计划的框架内。

在下一部分中，我们将根据国际临床指南，描述经导管闭合前心房通路临床和影像学评估的方案步骤。这些协议遵循塞梅尔威斯大学科学与研究伦理区域和机构委员会的指导方针。需要知情的书面患者同意。
1. 隐子卒中和PFO的经导管闭合的临床评估和工作流程
<ol><li>对于卒中的诊断性检查，使用计算机断层扫描 （CT） 或磁共振脑成像 （MRI） 确定卒中是缺血性?...

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G., 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=Guidelines+for+the+echocardiographic+assessment+of+the+right+heart+in+adults:+a+report+from+the+American+Society+of+Echocardiography+endorsed+by+the+European+Association+of+Echocardiography,+a+registered+branch+of+the+European+Society+of+Cardiology,+and+the+Canadian+Society+of+Echocardiography.">Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.</a> Journal of the American Society of Echocardiography. 23 (7), 685-713 (2010).</li><li>Wu, V. 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Part II.</a> European Heart Journal: Cardiovascular Imaging. 18 (12), 1322-1330 (2017).</li><li>Galderisi, 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=Standardization+of+adult+transthoracic+echocardiography+reporting+in+agreement+with+recent+chamber+quantification,+diastolic+function,+and+heart+valve+disease+recommendations:+an+expert+consensus+document+of+the+European+Association+of+Cardiovascular+Imaging.">Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging.</a> Europen Heart Journal: Cardiovascular Imaging. 18 (12), 1301-1310 (2017).</li><li>Marriott, K., Manins, V., Forshaw, A., Wright, J., Pascoe, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+right-to-left+atrial+communication+using+agitated+saline+contrast+imaging:+experience+with+1162+patients+and+recommendations+for+echocardiography.">Detection of right-to-left atrial communication using agitated saline contrast imaging: experience with 1162 patients and recommendations for echocardiography.</a> Journal of the American Society of Echocardiography. 26 (1), 96-102 (2013).</li><li>Mojadidi, M. K., 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=et+al+Accuracy+of+conventional+transthoracic+echocardiography+for+the+diagnosis+of+intracardiac+right-to-left+shunt:+a+meta-analysis+of+prospective+studies.">et al Accuracy of conventional transthoracic echocardiography for the diagnosis of intracardiac right-to-left shunt: a meta-analysis of prospective studies.</a> Echocardiography. 31 (9), 1036-1048 (2014).</li><li>Mojadidi, M. K., Bogush, N., Caceres, J. D., Msaouel, P., Tobis, J. 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S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=PFO+Closure+for+Cryptogenic+Stroke:+A+Review+and+Clinical+Treatment+Algorithm.">PFO Closure for Cryptogenic Stroke: A Review and Clinical Treatment Algorithm.</a> Cardiology in Review. 25 (4), 147-157 (2017).</li><li>Sanna, T., 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=Cryptogenic+stroke+and+underlying+atrial+fibrillation.">Cryptogenic stroke and underlying atrial fibrillation.</a> New England Journal of Medicine. 370 (26), 2478-2486 (2014).</li><li>Prefasi, D., Mart&#237;nez-S&#225;nchez, P., Fuentes, B., D&#237;ez-Tejedor, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+utility+of+the+RoPE+score+in+cryptogenic+stroke+patients+&#8804;50+years+in+predicting+a+stroke-related+patent+foramen+ovale.">The utility of the RoPE score in cryptogenic stroke patients &#8804;50 years in predicting a stroke-related patent foramen ovale.</a> International Journal of Stroke. 11 (1), 7-8 (2016).</li><li>Yamano, 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=et+al+Appropriate+selection+of+echocardiographic+guidance+for+transcatheter+atrial+septal+defect+closure.">et al Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure.</a> International Journal of Cardiovascular Imaging. 36 (5), 855-863 (2020).</li><li>Oto, 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=Transthoracic+echocardiography+guidance+during+percutaneous+closure+of+patent+foramen+ovale.">Transthoracic echocardiography guidance during percutaneous closure of patent foramen ovale.</a> Echocardiography. 28 (10), 1074-1080 (2011).</li></ol>

仔细选择经导管 PFO 闭合的患者是临床评估中最具有挑战性的步骤之一，因为排除心房颤动可能很困难。过去几年的几项试验表明，通过长期监测来检测心房颤动，可以提高产量。18 隐源性卒中和潜在心房颤动 （CRYSTAL-AF） 试验发现，与标准监测技术 （1.4%） 相比，可插入式心脏监护仪组的心房颤动发生率 （8.9%） 增加了 6 个月，在隐源性卒中患者中，这一比率攀升至 12.4% 和 2.0...

卵圆孔（PFO）不是房间隔的真正组织缺陷;它存在于约20-25%的成年人口中，在大多数情况下它没有任何临床意义（图1）。隐源性卒中约占缺血性卒中的 30%，被定义为在患者早期病情检查时没有明显病因的疾病。45岁以下的患者占卒中负担的10%，高达40%被定义为隐源性。使用经导管闭合技术对卒中进行二级预防对于降低发病率和死亡率仍然至关重要1。
房间隔缺损 （ASD） 包括不同房间隔位置的不同病变，导致分流。最常见的形式是肺动脉中段 ASD，通常最适合经脉功能闭合。ASD通常见于右心室（RV）功能障碍和/或扩张的病情检查期间，很少见于疑似矛盾性栓塞或隐源性卒中后2，3。
进行经胸 （TTE） 和经食管 （TEE） 超声心动图，以定性和定量评估房间隔缺损。三维（3D）TEE提供更深入的心房间隔信息，并在术中引导期间提供更精确的导管和闭合装置成像。术后 TTE 随访评估应在术后 1 个月、6 个月和 12 个月进行，随后每年进行评估，以评估器械位置、残余分流、心包积液、心房大小和功能的变化以及肺循环。使用斑点跟踪超声心动图的进一步高级超声心动图技术可能有助于了解经皮闭合后潜在的功能性左心房重塑及其对房性心律失常的影响2。

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			<td height="42" style="height:42px;width:219px;">TomTec Imaging workstation</td>
			<td style="width:242px;">TomTec Imaging, Unterschleissheim, Germany</td>
			<td style="width:151px;"></td>
			<td style="width:206px;">4D LALV Function analysing software</td>
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			<td height="42" style="height:42px;width:219px;">Ultrasound machine</td>
			<td style="width:242px;">Philips Epiq CvX</td>
			<td style="width:151px;">serial number US81881251</td>
			<td style="width:206px;">X5-1 and X7 transducers</td>
		</tr>
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			<td height="42" style="height:42px;width:219px;">Wiwe external ECG single chanel recorder</td>
			<td style="width:242px;">Sanat Metal</td>
			<td style="width:151px;">5-810-200-1611</td>
			<td style="width:206px;">external ECG single chanel recorder</td>
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echocardiographic evaluation of atrial communications before transcatheter closure

经胸 （TTE） 和经食管超声心动图 （TEE） 是房间隔缺损 （ASD） 和卵圆孔未闭 （PFO） 检测、患者选择经导管 ASD/PFO 闭合、术中指导和长期随访的标准影像学方法。确定心房通讯的大小，形状，位置和数量。通过使用搅拌盐水以及瞬时增加右心房（RA）压力的操作，可以提高PFO检测的准确性。RA 混浊后 3 个心脏周期内左心房 （LA） 出现微气泡被认为对存在心内分流呈阳性。三维 TEE 可进一步识别室间隔开窗，并描述 ASD/PFO 和房间间隔动脉瘤的动态形态。建议在手术后 1 个月、6 个月和 12 个月进行 TTE 随访评估，随后每年进行一次评估。先前的研究表明，装置闭合后早期房性心律失常的发生率增加。斑点追踪分析可能有助于了解经皮闭合后的功能性左心房重塑及其对房性心律失常的影响。

41岁女性患者有症状的临床评估显示腹腔型ASD和心房间隔松弛，采用TTE和TEE检查 TTE 检查显示右心室和双心室肿大伴肺动脉收缩压升高。TEE检查用于使用2D和3D方法估计ASD的大小和形状。比较了2D，3D原生和气球尺寸TEE测量值（图4， 图5， 图6）。在松软性房间隔的情况下，术中球囊尺寸非常重要，因为即使进行3D测量，在这种?...

Watch this Scientific Journal Video about Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure at JoVE.com

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

经胸 （TTE） 和经食管 （TEE） 超声心动图是房间隔间隔检查的基本成像工具。三维 （3D） TEE 为评估心房间隔提供增量信息。使用斑点跟踪超声心动图的进一步高级超声心动图技术应用于心腔的敏感容量和功能评估。

经导管闭合前心房通路的超声心动图评估

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale ...

经胸和经食管健康心电图是检测房间隔间隙缺陷、选择经导管闭合患者、指导心房间手术和随访患者的标准成像方法。因此，通过尺寸，经食管超声心动图提供了更深入的心房间隔信息，确定了心房间通路的大小，形状，位置和数量。三维超声心动图图像用于计划和指导心房间通路的治疗。经导管闭合的能见度评估和闭合装置的部署由该技术指导。左心房机械功能，与心脏病的预后密切相关。先进的超声心动图技术可以进一步阐明心房功能与心房间缺损闭合之间的相互作用。用于 2D 经胸超声心动图成像。当患者躺在左卧位，左臂放在头部下方时，使用尖峰下额叶四腔视图以获得良好的实际分辨率，以便沿其长轴测量缺陷的直径。使用伦理学四腔视图可估计心房间左向右分流（包括右心室扩张和右心室压）的血流动力学后果。然后，使用胸骨旁短轴视图测量室间隔缺损的主动脉和后肋。对于传统的容量和功能性左心房测量，可在斑点跟踪期间提供每个心脏周期的最高帧速率，而不会显着降低空间分辨率。在 2D 左心房应变曲线中设置左心室和舒张的零应变参考。并将每个相位的左心房应变值计算为其中两个测量值的差值。接下来，执行 2D 评估以允许测量三尖瓣环形平面收缩偏移。右心室分数区改变和多普勒组织成像Sprime速度。要评估右心室收缩功能，请进行3D分析。从心尖4腔视图获取心电图门控全体积的3D数据集，用于3D左心室和右心室体积和功能测量。在 2D 参数上使用增量预后值。然后，进行常规的 2D 容积和功能性左心房和心室测量。包括，使用二尖瓣流入和年度组织多普勒成像进行左心室舒张功能评估，并评估右心室整体纵向应变。在获得知情书面同意后，将至少四小时禁食的患者置于适当的位置，取出的牙科固定装置，并应用合适的热带口腔叶绿素麻醉剂和静脉注射镇静剂。在整个过程中监测超声心动图血压和血氧饱和度。使用图像定义缺陷的数量、大小和位置。以及周围的房间隔组织边缘，以及房间隔动脉瘤的存在。使用常规的 2D 和 3D 经食管超声心动图视图来确定动脉间隔缺损的后果。经电缆和主动脉瓣的食管中部短轴视图是评估 ASD 的最重要方面。为了验证通过孔的通信在瓣膜细胞期间使用搅拌注射器造影剂进行操作。当右心房压力暂时增加时，重叠的鼻中隔原位和将打开，气泡将在三个心脏周期内从右心房穿过阵列状卵圆孔管到左心房。对于 3D 经食管超声心动图成像，在食管中短轴视图中，使用窄角和广角模式获取有关房间隔间隔复杂动态解剖结构的其他信息，并在右动脉或左动脉的 alphas 视图中测量心房、舒张和收缩处房间隔缺损的大小。接下来，通过电缆和短轴视图使用食管中部，将导线推进到专利卵形孔隧道中。并将房间隔缺损前将闭合装置送入到位。然后，使用透视和经食管超声心动图成像对房间隔缺损的拉伸直径进行球囊大小调整。在分离给药系统之前获得所有测量值后，评估是否存在残余分流评估，并使用四腔短轴和两室经食管超声心动图视图来测量房间隔组织边缘和心房顶部到闭合装置的距离。在该代表性分析中，经胸超声心动图检查用于评估右心室和双心室肿大以及肺动脉收缩压。经食管超声心动图检查用于使用2D和3D方法估计房间隔缺损的大小和形状。在这个互操作的3D变焦图像中，可以观察到左心房闭合装置专利领班的左侧圆盘开口，该开口位于心房内隔。在完全部署后，可以使用左侧和右侧椎间盘之间的房间隔来观察该设备，如通过2D成像使用正确尺寸的术中球囊进行说明，这对于获得准确的测量至关重要。与松软性房间隔一样，即使进行3D测量，也可以低估完全拉伸的房间隔缺损大小。心脏 MRI 仍可在室间隔缺损闭合后进行。正确特定功能和大小的变化以及残留物的评估这些都是该方法可以回答的问题。先进的心电图技术 使用斑点跟踪方法可以应用于心房的敏感容量和功能评估，以评估潜在的心房补救联系。

Research

JoVE Journal

Medicine

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

守望的左心耳封闭装置心房颤动

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States 1. Since AF affects primarily ...

科研

医学

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

结合消融房颤左心耳封堵

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and ...

Echocardiographic Assessment of the Right Heart in Mice

右心小鼠的超声心动图评价

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

Robotic Ablation of Atrial Fibrillation

房颤消融机器人

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between ...

Echocardiographic and Histological Examination of Cardiac Morphology in the Mouse

超声心动图与小鼠心脏形态学的组织学检查

An increasing number of genetically modified mouse models has become available in recent years. Moreover, the number of pharmacological studies performed ...

Echocardiographic Measurement of Right Ventricular Diastolic Parameters in Mouse

小鼠右心室舒张参数的超声心电图测量

Diastolic dysfunction is a prominent feature of right ventricular (RV) remodeling associated with conditions of pressure overload. However, the RV ...

Transthoracic Echocardiographic Examination in the Rabbit Model

兔子模型中的跨胸超声心动图检查

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

Isolation of Atrial Myocytes from Adult Mice

从成年小鼠分离心膜肌细胞

The electrophysiological properties of atrial myocytes importantly affect overall cardiac function. Alterations in the underlying ionic currents ...

Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats

成人大鼠心脏解剖与功能的超声心动图评估

The use of experimental animal models has become crucial in cardiovascular science. Most studies using rodent models are focused on two-dimensional ...

Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor

与便携式刻度学监视器一起使用时，评估卡光采样线兼容性和准确性

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment ...