Guiding of Cardiovascular Surgery with Three and Four-dimensional Reconstruction of Transesophageal Echocardiograpy

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The main purpose of this research is firstly to develop a new three and four-dimensional (3D/4D) reconstruction system for transesophageal Echocardiographic (TEE) imaging and secondly to evaluate its utility for guiding cardiovascular surgery. In 1992 (the 1st year), our protype system was designed as follows : (1) Original TEE images were obtained sequentially with manual pull-back method. (2) Two cardiac cycles were recorded with VTR.(3) 3D reconstructions were achieved from the frame memories and beating 3D (4D) were reproduced synchronizing to ECG from 3D images. As initial clinical experience, we used this system in 14 patients (8 aortic aneurysms and 6 mitral prolapses). The summary of the 1st year's results were as follows : (1) In all 14 patients, 3D/4D reconstructions of TEE images were successfully obtained and the pathologies were correctly imaged allowing thorough three-dimensional understanding and inside view of 3D structure. (2) Using inexpensive computer, the mean proce … More ssing time was 3 hours.In 1993 (the 2nd year), the algorithm for detecting initimal surface was revised to improve image quality of 3D/4D images and the semi-automatic pull-back scanner was introduced to shorten the processing time. The poor contact between the TEE transducer and the esophageal mucosa caused dropout of original signals resulting in less qualified 3D/4D images in almost one third of patients examined with this system.In 1994 (the 3rd year), for the acquisition of original signals the rotary method was used to minimize the dropout of original signals permitting better 3D/4D image quality. 3D/4D reconstruction technique was also applied to intravascular and intracardiac Echoes. The summary of the 3rd year's results were as follows : (1) 3D/4D reconstruction of TEE was especially useful in aortic dissection and mitral valve repairing surgeries. (2) 3D/4D image quality was higher with rotary method than pull-brck. (3) 3D/4D images of intravascular and intracardiac Echoes were found surgically useful in aortic valve surgery and catheter interventions for ASD/VSD closures. In conclusion, the present research suggests that a newly developed 3D/4D reconstruction system, if data-processing time can be shortend enough, may be accepted as a future diagnostic tool in operating room, especially in guiding cardiobascular surgery to design its procedure and simulation surgery. Less