Insights Gained From Three-Dimensional Imaging Modalities for Closure of Ventricular Septal Defects
Insights Gained From Three-Dimensional Imaging Modalities for Closure of Ventricular Septal Defects
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DOI：
10.1161/circimaging.114.002502
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发表时间：
2014-11-01
影响因子：
7.5
通讯作者：
Simpson, John M.
中科院分区：
文献类型：
--
作者：
Charakida, Marietta;Pushparajah, Kuberan;Simpson, John M.
对于大到足以容纳3D经食管超声心动图探头（通常> 25 kg）的患者，这产生室间隔的极高分辨率图像，特别是膜间隔和靠近AV瓣膜的肌间隔。在这些作者的经验中，0、40至60和120的角度都有利于可视化室间隔。准确的探头位置、旋转角度和弯曲度根据个体化进行调整，主要是为了实现不平行于室间隔本身的成像投影。在双致缺损和合并主动脉瓣尖脱垂的病例中，120的优点是缺损和瓣尖脱垂在同一投影中显示最佳。在某些情况下，经胃视图是有帮助的，因为超声与室间隔正交，但这些投影特别倾向于整个心动周期的心脏运动。在适当的情况下，在采集期间短暂使用通气暂停。使用3D彩色血流多普勒可以帮助确定缺损的大小并定位通过VSD的真实血流。3D彩色流的局限性在于，与没有彩色的3D相比，时间分辨率显著降低。此外，如果要避免不可接受的低帧速率，则可以询问的感兴趣区域相对较小。当在几个心动周期期间获得体积时，运动伪影仍然是一个重要问题。为了与2DE上的彩色血流多普勒保持一致，必须调整最佳色标，尽管可以在使用3D技术的后处理期间调整颜色增益。我们的彩色血流多普勒评估VSD的方法涉及使用交叉平面成像，其使用3D矩阵探头同时投影2个用户定义的正交平面的能力。在我们目前的临床实践中，我们还没有使用3DE来计算流量或肺：体循环流量比。这些参数的准确测定是我们部门正在进行的研究领域，但目前尚未扩展到临床研究。11
For patients who are large enough to accommodate the 3D transesophageal echocardiography probe (typically> 25 kg), this produces extremely high-resolution images of the ventricular septum particularly the membranous septum and the muscular septum close to the AV valves. In these authors’ experience angles of 0, 40 to 60, and 120 are all good to visualize the ventricular septum. The exact probe position, rotational angle, and flexion are adjusted on an individualized basis, mainly to achieve an imaging projection, which is not parallel to the ventricular septum itself. In cases of doubly committed defects and those complicated by aortic cusp prolapse, 120 has the benefit that both the defect and the cusp prolapse are visualized optimally in the same projection. Transgastric views are helpful in some cases because the insonation is orthogonal to the ventricular septum, but these projections are particularly prone to whole heart motion through the cardiac cycle. Suspension of ventilation is used briefly during acquisition where appropriate. The use of 3D color flow Doppler may assist in sizing of defects and localizing true flow through a VSD. The limitations with 3D color flow are that the temporal resolution is significantly reduced when compared with 3D without color. Furthermore, the area of interest, which can be interrogated, is relatively small if unacceptably low frame rates are to be avoided. Motion artifact remains a significant issue when volumes are obtained during several cardiac cycles. In keeping with color flow Doppler on 2DE, the optimal color scale has to be adjusted although color gain can be adjusted during postprocessing using the 3D technique. Our approach to color flow Doppler assessment of VSDs involves the use of cross plane imaging, which uses the capacity of the 3D matrix probe to project 2 user-defined orthogonal planes simultaneously. In our current clinical practice, we have not used 3DE to calculate flow or pulmonary: systemic flow ratio. Accurate determination of these parameters is an ongoing area of research in our department but does not currently extend to clinical studies. 11