この作品は、ハンガリー政府研究基金[GINOP-2.3.2-15-0016-00043、Szív-és érkutatási kiváósáágközpont(IRONHEART)]によって資金提供されました。

すべての患者は、地元の倫理委員会(OGYÉI/12743/2018)の承認に従って、検査前にインフォームド・コンセントに署名しました。
1. 準備
<ol><li>患者の準備で検査を開始する:少なくとも4時間の断食状態、嚥下の問題および既知の上部消化管疾患に関するアンケートを確保する。</li>
	<li>書面によるインフォームド・コンセントが読み取られ、署名されていることを確認します。</li>
	<li>検査の前に静脈内ラインを準備する。</li>
	<li>患者を左横の褥瘡の位置に置く。</li>
	<li>静脈内ミダゾラム(2.5-5mg)を使用して軽度の鎮静を投与する。</li>
	<li>ECGと酸素飽和度を監視します。</li>
</ol>2. 画像取得
<ol><li>左のPVの可視化<ol>
<li>前歯から約30~40cmで食道にプローブを挿入します。</li>
		<li>上部(または中)の横(または中)の経食道プローブの位置は、20~45°の2D画像取得を使用してLAAを可視化します。</li>
		<li>プローブを少し時計回りに回し、画像上のLAAを一元化するために結晶のアンギュレーションを60〜80°に変更します。</li>
		<li>フルボリューム3D集録を適用するためにフルボリュームボタンをクリックします。</li>
		<li>画像の横方向と高さ幅を調整して、LAA と左上の PV を表示します。これは左の側面の尾根の視覚化を高める。</li>
		<li>画像の品質を最適化します(深さとゲインを調整し、高調波イメージングを適用します)。</li>
		<li>2つの心周期の1拍(可能であれば、マルチビート)ループを記録する。</li>
		<li>LAAを一元化するには、2D画像で約120°にアンギュレーションを変更します。</li>
		<li>プローブを少し反時計回りに回し、前反射を適用して左のPVのオスティアを視覚化します。</li>
		<li>カラードップラーでコードされたイメージングを適用して、上部と下部の両方のPVが表示されていることを確認します。</li>
		<li>フルボリューム3D集録を適用するためにフルボリュームボタンをクリックします。</li>
		<li>イメージの横方向と高さ幅を調整して、左の PV を表示します。これは左上および下のPVおよび介在する尾根のオスティアの視覚化を高める。</li>
		<li>データセットの品質を制御します。記録されたデータセットを確認します。データセットに上側と下側の両方のPVが含まれていない場合は、患者の位置をさらに横方向の位置に傾けて変更し、ステップ2.1.8から手順を繰り返します。</li>
		<li>左のPVから3Dフルボリュームデータセットを取得:2心周期でワンビート(可能であれば、マルチビート)ループ。</li>
		<li>PV ostiaの可視性を確認するには、画像をそれぞれ上部または下部のPVオシウムにトリミングします。PVオシウムの下側には、特に注意深い確認が必要です。オシウムの一部が解剖学的な理由、例えばアンギュレーションまたはトランスデューサーに近接しているため、3Dデータセットの外にあることは、説得力がありません。</li>
		<li>画像が完全なPV構造を視覚化するのに適していない場合は、手順2.1.10から手順を繰り返します。必要に応じて、3D データセットの横方向または標高の幅を変更します。</li>
	</ol>
</li>
	<li>適切なPVの可視化<ol>
<li>2Dモードに戻り、45°上部(または中間)の食道プローブ位置で画像をLAAに焦点を合わせます。</li>
		<li>プローブを時計回りに回し、プローブヘッドを前反射位置に移動して、右のPVを視覚化します。</li>
		<li>カラードップラーでコードされたイメージングを適用して、上部と下部の両方のPVが表示されていることを確認します。</li>
		<li>フルボリューム3D集録を適用するためにフルボリュームボタンをクリックします。</li>
		<li>イメージの横方向と高さ幅を調整して、適切な PV を表示します。これは、右上と下のPVと介在する尾根のオスティアの可視化を強化します。このイメージは、超数的な PV の存在を識別するために使用できます。</li>
		<li>2つの心周期のワンビート(可能であれば、マルチビート)ループの右のPVから3Dフルボリュームデータセットを取得します。</li>
		<li>PV ostiaの可視性を確認するには、画像をそれぞれ上部または下部のPVオシウムにトリミングします。PVオシウムの下側には、特に注意深い確認が必要です。解剖学的な理由(例えば、アンギュレーションやトランスデューサへの近接性)のために、オスチウムの一部が3Dデータセットの外にあることは珍しいことではありません。</li>
		<li>データセットに上側と下側の両方のPVが含まれていない場合、患者の位置を右の位置にさらに傾けることで変更し、手順はステップ2.2.1から繰り返す必要があります。必要に応じて、3D データセットの横方向または標高の幅を変更します。</li>
	</ol>
</li>
</ol>3.3D画像の再構成と測定
<ol><li>オフライン3D多平面再建<ol>
<li>スキャナーまたはワークステーションで 3D 解析ソフトウェアをアクティブにします (フィリップス: QApps パネルで 3DQ ソフトウェアをアクティブ化します。トムテック:4Dカーディオビュー3アプリケーションをアクティブにします。GE: フレキシスライスソフトウェアをアクティブ化します)。</li>
		<li>測定のために拡張期相のフレームを選択します。標準化の場合は、T波に対してタイミングを合わせたフレームを選択することをお勧めします。</li>
		<li>2 つの垂直面を要求された構造(左横方向の尾根または各 PV ostium)に設定し、平面の方向を調整し、3 番目 の平面は検査した構造の 面 図を表します。</li>
		<li>左側のパネルで、測定オプションを選択します。 エン面 ビューは測定(直径、面積、距離)に適しています。</li>
	</ol>
</li>
</ol>

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著者らは利益相反を報告していない。

ここでは、3D心エコーでのPV、周囲の構造、解剖学的特性を研究するためのステップバイステップの方法論を示す。上記のPVの3Dイメージング法は、正確な測定に適したほとんどの患者に高品質の3D画像を提供する、簡単に標準化可能な方法です。PV解剖学の適切な評価のために、取得した画像の最適な品質と向きが最も重要です。3D再構成された画像は、PV排水パターンとその解剖学的変動の視...

肺静脈(PV)の排水パターンは、平均人口の56.5%の変動で非常に変動する1。PV排液パターンの評価は、現在の心房細動の最も一般的な介入治療であるPV分離(PVI)を計画する際に重要です。無線周波カテーテルアブレーションはPVIを達成するための標準的な技術でしたが、クライオバルーン(CB)ベースのアブレーション技術(CA)は、より少ない手続き時間を必要とする代替方法です。この技術は、無線周波アブレーション5,6と比較してそれほど複雑ではなく、CAの有効性と安全性は無線周波アブレーション7の有効性と同様である。
CBによる手続き型PV閉塞の速度とPVオシウムにおける組織損傷の連続的な周回延長は、CAの後のPVIの永久的な成功を決定する。PV閉塞の主な決定因子の1つはPV解剖学の変化である。最近、コンピュータ断層撮影(CT)および心臓MRIベースの研究では、いくつかのPVパラメータがCAに続く短期および長期の成功率の予測値で同定された。これらのパラメータには、PV解剖学(左共通PV、超数Pv8、9、10、楕円形の面積、楕円形指数8、11、12、13)とその周辺(内在性リッジ8、14、15、16、左横尾根8、9、17の厚さ)の両方のバリエーションが含まれていました。
従来の2D心エコーは、上記のパラメータの大部分を表示および測定するのに適していないが、3次元横隔膜心エコー検査(3D TEE)は、以前の文献データ18,19に示したように、PVを視覚化するための代替ツールであると思われる。
さらに、PVI以前の3D TEEは、手続き設計のためのPV特性に関するデータを提供するだけでなく、左心房付属器(LAA)に血栓が存在するかどうかを明確にするため、CTまたはMRIと比較して付加価値をもたらします。この調査は、PVIの前に特に重要です。同時に、3D TEEは、より少ない時間を必要とし、その手続きコストは低く、それは放射線に患者と医療スタッフを公開しません。
以前は、サイズが異なる複数のタイプの CB が存在し、さまざまなパラメータが CA の成功率に与える影響を推定することが困難でした。現在、新たに導入された第 2 世代 CB は、1 つのサイズにしか存在しない CA に使用されています。冷却効果が向上した結果、第2世代CBは第1世代のCB20に比べてはるかに高い性能を発揮し、PVI以前のPV解剖学と介入計画の重要性をさらに強調しています。

<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

肺静脈の寸法は、特にクライオバルーンアブレーション技術で肺静脈分離(PVI)を計画する際の重要なパラメータです。肺静脈(PV)の寸法と解剖学的変動を認めることは、介入の結果を改善する可能性がある。従来の2D食道心エコー検査では、PVの寸法に関する限られたデータしか提供できません。ただし、3D心エコーは、関連する直径と PV の領域、および周囲の構造物との空間的な関係をさらに評価できます。以前の文献データでは、PVIの成功率に影響を与えるパラメータはすでに特定されています。これらは、左横尾根、介在する尾根、PVのオスティアル領域、オスティウムの楕円形指数です。3D心エコーによるPVの適切なイメージングは、技術的に困難な方法です。重要なステップの1つは、画像のコレクションです。重要な構造を可視化するには、3つの個別のトランスデューサ位置が必要です。これらは左横尾尾根、PVのオシウム、および左と右のPVの介在する尾根です。次に、3D画像を取得し、デジタルループとして保存します。これらのデータセットはトリミングされ、空間リレーションシップを表示する面ビューが表示されます。このステップは、PV の解剖学的バリエーションを決定するためにも使用できます。最後に、複数の平面的な再構成を作成して、PV の個々のパラメータを測定します。
PV解剖学の適切な評価のために、取得した画像の最適な品質と向きが最も重要です。本研究では、80人の患者におけるPVの3D視認性と上記方法の適合性を調べた。その目的は、3D心エコー検査によるPV可視化と評価の重要なステップと潜在的な落とし穴の詳細な概要を提供することであった。

上述した画像取得プロトコルを用いて、第1のステップは、2D集録を用いて左心房付属器(LAA)を可視化するものである(図1)。プローブは、20~45°の上(または中間)の経食道位置にあります。画像は LAA を示しています。左横尾根と左上のPVは60~80°で表示され(図2)、3Dデータセットを取得し、左上のPVオチウムでLAAと左横尾根を視覚化するためにデータセ?...

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

肺静脈(PV)の寸法は、肺静脈の分離を計画する際の重要なパラメータです。2D食道心エコー検査では、PVに関する限られたデータしか提供できません。ただし、3D 心エコーは、関連する直径と PV の領域、および周囲の構造物との空間的な関係を評価できます。

肺静脈の特異的パラメータの可視化と評価のための3次元心エコー法

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

Universidad de Cartagena UDEC

Research

JoVE Journal

Bioengineering

2.7K ビュー.  University of Debrecen. 肺静脈(PV)の寸法は、肺静脈の分離を計画する際の重要なパラメータです。2D食道心エコー検査では、PVに関する限られたデータしか提供できません。ただし、3D 心エコーは、関連する直径と PV の領域、および周囲の構造物との空間的な関係を評価できます。

ビデオ: 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.

マウスにおける経胸壁心エコー

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

医学

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.

経胸壁心エコー検査による肺動脈狭窄のマウスモデルにおける右室の構造と機能の評価

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.

マウスの弁膜症の包括的表現型の特徴のための心エコーアプローチとプロトコル

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.

3D心エコーを用いた左心室構造と機能の評価

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

生物工学

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.

ウサギモデルにおける経胸部心エコー検査

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.

3次元心エコー検査を用いた右心室の形態学的・機能的評価

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.

経カテーテル肺弁交換のための4次元コンピュータ断層撮影ガイド付きバルブサイジング

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

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography

Targeted neonatal echocardiography (TnECHO) refers to the use of comprehensive echocardiographic evaluation and physiologic data to obtain accurate, reliable, and real-time information on developmental hemodynamics in sick newborns. The comprehensive assessment is based on a multiparametric approach that overcomes the reliability issues of individual measurements, allows for earlier recognition of cardiovascular compromise and promotes enhanced diagnostic precision and timely management. TnECHO-driven research has led to an enhanced understanding of the mechanisms of illness and the development of predictive models to identify at-risk populations. This information may then be used to formulate a diagnostic impression and provide individualized guidance for the selection of cardiovascular therapies. TnECHO is based on the expert consultative model in which a neonatologist, with advanced training in neonatal hemodynamics, performs comprehensive and standardized TnECHO assessments. The distinction from point of care ultrasonography (POCUS), which provides limited and brief one-time assessments, is important. Neonatal hemodynamics training is a 1-year structured program designed to optimize image acquisition, measurement analysis, and hemodynamic knowledge (physiology, pharmacotherapy) to support cardiovascular decision-making. Neonatologists with hemodynamic expertise are trained to recognize deviations from normal anatomy and appropriately refer cases of possible structural abnormalities. We provide an outline of neonatal hemodynamics training, the standardized TnECHO imaging protocol, and an example of representative echo findings in a hemodynamically significant patent ductus arteriosus.

Presented here is a protocol to perform comprehensive neonatal echocardiography by trained neonatologists in the neonatal intensive care unit. The trained individuals provide longitudinal assessments of heart function, systemic and pulmonary hemodynamics in a consultative role. The manuscript also describes the requirements to become a fully trained neonatal hemodynamics specialist.

標的新生児心エコー検査を用いた新生児集中治療室における血行動態の精度

Targeted neonatal echocardiography (TnECHO) refers to the use of comprehensive echocardiographic evaluation and physiologic data to obtain accurate, ...

左心房と肺静脈のICEベースの3Dリモデリング

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.

著者スポットライト:心房解剖学評価のための心臓内心エコー検査の進歩 

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.

精密な心臓内心エコー法による左心房と肺静脈の3次元モデリング

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