Intrapericardial echocardiography: A novel catheter-based approach to cardiac imaging
Intrapericardial echocardiography: A novel catheter-based approach to cardiac imaging
复制标题
DOI：
10.1016/j.echo.2003.10.024
复制
发表时间：
2004-03-01
影响因子：
6.5
通讯作者：
Reddy, VY
中科院分区：
文献类型：
--
作者：
Rodrigues, ACT;d'Avila, A;Reddy, VY
背景：经血管导管为基础的心内超声心动图已经成功地用于指导导管消融和电生理手术。最近有研究表明，导管可以安全地放置在心包空间，以便心外膜心脏定位和消融。我们评估了导管为基础的心包内超声心动图（IPE）的可行性，以识别心脏结构和可视化心内导管。方法：在7只山羊的心包内放置一个包含在10F可操纵导管内的相控阵超声换能器。采用经胸椎弓骨下入路探查和消融心外膜室性心动过速。获得了心脏结构和心内消融导管的图像。手术后，摘取心脏以评估可能的ipe相关病变。结果：所有动物心包穿刺导管均可顺利置入心包腔内。7例中有7例获得了左右侧心室和瓣膜的纵向和短轴视图，其定位与经食管超声心动图相似。可见心房附件（6/7）、肺静脉（6/7）、冠状动脉（6/7）和冠状窦（3/6）。通过光谱和彩色多普勒评估心内经瓣血流和静脉血流量。消融导管在心室内清晰可见。操作IPE导管未发生心律失常。在采集心脏后，没有观察到手术造成的损伤。结论：在本实验环境下，IPE能够提供详细的心脏结构图像，并确定消融导管的相对位置。
Background: Transvascular catheter-based intracardiac echocardiography has been successfully used to help guide catheter ablation and electrophysiologic procedures. it has recently been demonstrated that catheters can be safely placed into the pericardial space to allow for epicardial cardiac mapping and ablation. We evaluated the feasibility of catheter-based intrapericardial echocardiography (IPE) during such procedures to identify cardiac structures and visualize intracardiac catheters.Methods: IPE was performed in 7 goats by placing a phased-array ultrasound transducer contained within a 10F steerable catheter into the pericardial. space using the same transthoracic subxyphoid approach as used to map and ablate epicardial ventricular tachycardia. Images were obtained of cardiac structures and of intracardiac ablation catheters. After the procedure, the hearts were harvested to assess for possible IPE-related lesions.Results: The IPE catheter could be easily placed inside the pericardial space in all animals. In 7 of 7 cases, longitudinal and short-axis views of right- and left-sided chambers and valves were obtained, similar in orientation to transesophageal echocardiography. Visualization of atrial appendages (6/7), pulmonary veins (6/7), coronary arteries (6/7), and coronary sinus (3/6) was also feasible. Assessment of intracardiac transvalvar and venous blood flow was achieved by spectral and color Doppler. The ablation catheter could be clearly visualized inside cardiac chambers. No arrhythmias were induced with IPE catheter manipulation. After harvesting the hearts, no lesions resulting from the procedure were observed.Conclusion: In this experimental setting, IPE was able to provide detailed images of cardiac structures and establish the relative position of the ablation catheter.