이 작품은 헝가리 정부 연구 기금 [GINOP-2.3.2.15-2016-00043, Szív-és ékutatási kiválóságözpont (IRONHEART)]에 의해 지원되었다.

모든 환자는 지역 윤리위원회의 승인에 따라 검사 전에 통보 된 동의에 서명 (OGYÉI/ 12743/2018).
1. 준비
<ol><li>환자 준비로 검사를 시작합니다 : 적어도 4 시간 금식 상태, 삼키는 문제와 알려진 상부 위장 질환에 대한 설문 지 킴)</li>
	<li>서면 정보에 입각한 동의를 읽고 서명하도록 합니다.</li>
	<li>검사 전에 정맥 라인을 준비합니다.</li>
	<li>환자를 왼쪽 측면 디큐비투스 위치에 배치합니다.</li>
	<li>정맥 미다졸람 (2.5-5 mg)을 사용하여 가벼운 체멸을 투여하십시오.</li>
	<li>심전도 및 산소 포화도를 모니터링합니다.</li>
</ol>2. 이미지 수집
<ol><li>왼쪽 TV의 시각화<ol>
<li>앞니에서 약 30-40cm의 식도에 프로브를 삽입합니다.</li>
		<li>상부(또는 중간) 트랜스식도 프로브 위치에서 20-45°에서 2D 이미지 수집을 사용하여 LAA를 시각화합니다.</li>
		<li>프로브를 시계 방향으로 약간 돌리고 이미지의 LAA를 중앙 집중화하기 위해 결정 각도를 60-80°로 변경합니다.</li>
		<li>전체 볼륨 3D 인수를 적용하려면 전체 볼륨 버튼을 클릭합니다.</li>
		<li>이미지의 측면 및 고도 너비를 조정하여 LAA와 왼쪽 위 PV를 표시합니다. 이렇게 하면 왼쪽 측면 능선의 시각화가 향상됩니다.</li>
		<li>이미지 품질을 최적화합니다(깊이와 게인을 조정하고 고조파 이미징을 적용함).</li>
		<li>2 개의 심장 사이클로 1 비트 (가능한 경우 멀티 비트) 루프를 기록합니다.</li>
		<li>LAA를 중앙 집중화하기 위해 2D 이미지에서 약 120°로 각도를 변경합니다.</li>
		<li>프로브를 시계 반대 방향으로 약간 돌리고 앤티플렉션을 적용하여 왼쪽 TV의 진동을 시각화합니다.</li>
		<li>색상 도플러 코딩 이미징을 적용하여 상부 및 하부 TV가 모두 표시되는지 확인합니다.</li>
		<li>전체 볼륨 3D 인수를 적용하려면 전체 볼륨 버튼을 클릭합니다.</li>
		<li>이미지의 측면 및 고도 너비를 조정하여 왼쪽 TV를 표시합니다. 이렇게 하면 왼쪽 상부 및 하부 TV의 진동과 중간 능선의 시각화가 향상됩니다.</li>
		<li>데이터 집합 품질을 제어합니다. 기록된 데이터 집합을 확인합니다. 데이터 집합에 상하형 TV가 모두 포함되어 있지 않으면 측면 위치로 기울어져 환자의 위치를 변경하고 2.1.8 단계에서 절차를 반복합니다.</li>
		<li>왼쪽 TV에서 3D 전체 볼륨 데이터 집합을 획득합니다: 2개의 심장 사이클이 있는 원비트(가능한 경우 멀티비트) 루프.</li>
		<li>이미지를 각각 상부 또는 하부 PV 타스트로 자르면 PV 오스티아의 가시성을 확인합니다. 낮은 PV 타륨은 특별히 신중하게 확인해야합니다. 타륨의 일부가 해부학적 이유로 인해 3D 데이터 집합 외부에 있다는 것은 unsual가 아니며, 예를 들어 배앙 또는 트랜스듀서에 가까운 근접성.</li>
		<li>이미지가 전체 PV 구조를 시각화하기에 적합하지 않은 경우 2.1.10 단계에서 절차를 반복하십시오. 필요한 경우 3D 데이터 집합의 측면 또는 고도 너비를 변경합니다.</li>
	</ol>
</li>
	<li>올바른 TV의 시각화<ol>
<li>다시 2D 모드로 전환하고 이미지를 45° 위(또는 중간) 식도 프로브 위치에서 LAA에 집중합니다.</li>
		<li>프로브를 시계 방향으로 돌리고 프로브 헤드를 앤티플렉시온 위치로 이동하여 올바른 TV를 시각화합니다.</li>
		<li>색상 도플러 코딩 이미징을 적용하여 상부 및 하부 TV가 모두 표시되는지 확인합니다.</li>
		<li>전체 볼륨 3D 인수를 적용하려면 전체 볼륨 버튼을 클릭합니다.</li>
		<li>이미지의 측면 및 고도 너비를 조정하여 올바른 TV를 표시합니다. 이렇게 하면 오른쪽 상부 및 하부 TV와 중간 능선의 진동이 향상됩니다. 이 이미지는 초숫자 TV의 존재를 식별하는 데 사용할 수 있습니다.</li>
		<li>오른쪽 TV에서 3D 전체 볼륨 데이터 집합을 획득합니다: 2개의 심장 사이클이 있는 원비트(가능한 경우 멀티비트) 루프.</li>
		<li>이미지를 각각 상부 또는 하부 PV 타스트로 자르면 PV 오스티아의 가시성을 확인합니다. 낮은 PV 타륨은 특별히 신중하게 확인해야합니다. 해부학적 이유(예:, 배앙 또는 트랜스듀서에 근접)로 인해 타륨의 일부가 3D 데이터 집합 외부에 있는 것은 드문 일이 아닙니다.</li>
		<li>데이터 집합에 상하형 TV가 모두 포함되어 있지 않으면 환자 위치를 올바른 위치로 추가로 기울어서 변경해야 하며 절차는 2.2.1 단계에서 반복되어야 합니다. 필요한 경우 3D 데이터 집합의 측면 또는 고도 너비를 변경합니다.</li>
	</ol>
</li>
</ol>3.3D 이미지 재구성 및 측정
<ol><li>오프라인 3D 멀티 플래나 재구성<ol>
<li>스캐너 또는 워크스테이션에서 3D 분석 소프트웨어를 활성화(필립스: QApps 패널에서 3DQ 소프트웨어 활성화; Tomtec: 4D 심장 보기 3 응용 프로그램을 활성화; GE: FlexiSlice 소프트웨어를 활성화합니다).</li>
		<li>측정을 위해 확장기 단계에서 프레임을 선택합니다. 표준화를 위해 T 웨이브에 걸리는 프레임을 선택하는 것이 좋습니다.</li>
		<li>두 수직 평면을 요청된 구조(왼쪽 측면 능선 또는 각 TV 타편)로 설정하고 평면 방향을 조정하고 3번째 평면은 검사된 구조의 en 얼굴 뷰를 나타냅니다.</li>
		<li>왼쪽 패널에서 측정 옵션을 선택합니다. en 페이스 뷰는 측정(직경, 면적, 거리)에 적합합니다.</li>
	</ol>
</li>
</ol>

<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>

저자는 이해 상충을 보고합니다.

여기에서, 우리는 3D 심초음파를 가진 TV, 그들의 주변 구조물 및 해부학적 특성을 연구하기 위하여 단계별 방법론을 보여줍니다. 상기 설명된 3D 영상형 TV는 정밀측정에 적합한 대부분의 환자에서 고품질3D 영상을 제공하는 표준화가능한 방법입니다. 획득한 이미지의 최적의 품질과 방향은 PV 해부학의 적절한 평가를 위해 가장 중요합니다. 3D 재구성 된 이미지는 PV 배수 패턴의 시각화와 해부학적 ...

폐 정맥(PV)의 배수 패턴은 평균 인구1에서 56.5%의 변동으로 매우 가변적입니다. PV 배수 패턴의 평가는 현재 심방 세동의 가장 일반적인 중재 치료인 PV 격리(PVI)를 계획할 때 매우 중요합니다2,3,4. 무선 주파수 카테터 절제는 PVI를 달성하기위한 표준 기술이지만, 저온 풍선 (CB)기반 절제 기술 (CA)은 적은 절차 시간을 필요로하는 대안 방법입니다. 이 기술은 무선 주파수 절제에 비해 덜 복잡5,6, CA의 효능과 안전은 무선 주파수 절제의 것과 유사하는 동안7.
CB에 의한 절차PV 폐색속도와 PV 오스티움에서 조직 손상의 연속적인 일주 연장은 CA 이후 PVI의 영구적인 성공을 결정한다. PV 폐색의 주요 결정요인 중 하나는 PV 해부학의 변화입니다. 최근, 컴퓨터 단층 촬영-(CT) 및 심장 MRI 기반 연구, 여러 PV 매개 변수는 CA 다음 단기 및 장기 성공률의 예측 값으로 확인 되었다. 이러한 매개 변수는 PV 해부학 (왼쪽 공통 PV, 초숫자 PVs8,9,10, 골영역, 타원형 지수8,11,12,13) 및 그 주변의 변형을 포함 (중간 능선8,14,15,16, 왼쪽 측광 의 두께8,9,17).
기존의 2D 에코카디그래피는 위의 파라미터의 대부분을 표시하고 측정하는 데 적합하지 않지만, 3차원 측피식 에코카르디그래피(3D TEE)는 이전 문헌 데이터18,19에서 입증된 바와 같이 TV를 시각화하는 대체 도구가 될 것으로 보인다.
또한, PVI 이전의 3D TEE는 CT 또는 MRI에 비해 추가가치를 제공하며, 절차적 설계를 위한 PV 특성에 대한 데이터를 제공할 뿐만 아니라 왼쪽 심방 부속술(LAA)의 혈전이 존재하는지 여부를 명확히 합니다. 이 조사는 PVI 이전에 특히 중요합니다. 동시에 3D TEE는 시간이 적게 필요하고 절차 비용이 낮으며 환자와 의료진을 방사선에 노출시키지 않습니다.
과거에는 여러 유형의 CV가 서로 다른 크기로 존재하여 다양한 유형의 CV가 CA의 성공률에 미치는 영향을 추정하기가 어려웠습니다. 오늘날 새로 도입된 2세대 CB는 CA에 사용되며, 이는 한 가지 크기로만 존재합니다. 향상된 냉각 효과 덕분에 2세대 CB는 1세대 CB20에 비해 훨씬 높은 성능을 제공하며, 이는 PVI 이전의 PV 해부학 및 중재 계획의 중요성을 더욱 강조합니다.

<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

폐 정맥의 치수는 폐 정맥 격리 (PVI)를 계획 할 때 중요한 매개 변수이며, 특히 극저온 절제 기법을 사용합니다. 폐 정맥 (TV)의 치수와 해부학 적 변화를 인정하는 것은 개입의 결과를 향상시킬 수 있습니다. 기존의 2D 환식 식 수심 에코카디그래피는 TV의 치수에 대한 제한된 데이터만 제공할 수 있습니다. 그러나 3D 에코카르디그래피는 주변 구조물과의 공간 관계뿐만 아니라 PV의 관련 직경 및 영역을 더욱 평가할 수 있습니다. 이전 문헌 데이터에서 PVI의 성공률에 영향을 미치는 매개 변수는 이미 확인되었습니다. 이들은 왼쪽 측면 능선, 중간 능선, TV의 골측 영역 및 타튬의 타원형 인덱스입니다. 3D 에코카르디오그래피에 의한 적절한 SUV 이미징은 기술적으로 어려운 방법입니다. 한 가지 중요한 단계는 이미지 모음입니다. 중요한 구조를 시각화하려면 세 개의 개별 트랜스듀서 위치가 필요합니다. 이들은 왼쪽 측면 능선, TV의 타골 및 왼쪽 및 오른쪽 TV의 중간 능선입니다. 다음으로 3D 이미지를 획득하여 디지털 루프로 저장합니다. 이러한 데이터 집합이 자른 후 en face 뷰가 공간 관계를 표시합니다. 이 단계는 또한 TV의 해부학적 변이를 결정하기 위해 사용될 수 있다. 마지막으로, 멀티 플래나 재구성은 TV의 각 개별 매개 변수를 측정하기 위해 만들어집니다.
획득한 이미지의 최적의 품질과 방향은 PV 해부학의 적절한 평가를 위해 가장 중요합니다. 본 작업에서, 우리는 80명의 환자에서 위의 방법의 3D 가시성 및 위의 방법의 적합성을 검토했습니다. 목표는 3D 에코카르디그래피를 사용하여 PV 시각화 및 평가의 필수 단계와 잠재적 인 함정에 대한 자세한 개요를 제공하는 것이었습니다.

상기 영상 획득 프로토콜을 사용하여, 첫 번째 단계는 2D 획득(그림 1)을 사용하여 왼쪽 심방 부속술(LAA)을 시각화하는 것이다. 프로브는 20-45°에서 상부(또는 중간) 경식도 위치에 있습니다. 이미지는 LAA를 보여줍니다. 왼쪽 측면 능선과 왼쪽 상부 PV는 60-80°(그림 2)로 표시되고, 3D 데이터 세트는 왼쪽 상부 PV 오스트리움을 사용하여 LAA 및 왼쪽 측면 능선...

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

폐 정맥(PV)의 치수는 폐 정맥 격리를 계획할 때 중요한 매개 변수입니다. 2D 송도식체 에코카디그래피는 TV에 대한 제한된 데이터만 제공할 수 있습니다. 그러나 3D 에코카르디그래피는 주변 구조물과의 공간 관계뿐만 아니라 PV의 관련 직경 및 영역을 평가할 수 있습니다.

폐 정맥의 특정 매개 변수의 시각화 및 평가를 위한 3차원 심초음파 방법

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 조회수.  University of Debrecen. 폐 정맥(PV)의 치수는 폐 정맥 격리를 계획할 때 중요한 매개 변수입니다. 2D 송도식체 에코카디그래피는 TV에 대한 제한된 데이터만 제공할 수 있습니다. 그러나 3D 에코카르디그래피는 주변 구조물과의 공간 관계뿐만 아니라 PV의 관련 직경 및 영역을 평가할 수 있습니다.

비디오: 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.

마우스에 Transthoracic Echocardiography

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

연구

의학

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.

경 흉부 심 초음파에 의한 폐동맥 수축의 마우스 모델에서 마우스 오른쪽 심실 구조 및 기능의 평가

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.

마우스의 심장 판막 질환의 종합 표현형 특성에 대한 심 초음파 접근 및 프로토콜

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 에코카르디그래피를 사용하여 좌심실 구조 및 기능 평가

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

생체공학

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.

토끼 모델의 흉부 심초음파 검사

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 심 초음파를 사용한 우심실의 형태 학적 및 기능적 평가

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.

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.

표적 신생아 심장 초음파를 사용한 신생아 집중 치료실의 혈역학적 정밀도

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

좌심방 및 폐정맥에 대한 ICE 기반 3D 리모델링

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.

저자 스포트라이트: 심방 해부학 평가를 위한 심장 내 심초음파의 발전 

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.

정확한 심장 내 심장 초음파 접근 방식을 사용한 좌심방 및 폐 정맥의 3차원 모델링

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