CARDIAC ASSESSMENT IN ANESTHESIA BY 3D MEASUREMENT

通过 3D 测量进行麻醉中的心脏评估

• 批准号: 2220027
• 负责人: ROY W MARTIN
• 金额: $ 30.35万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1988
• 资助国家: 美国
• 起止时间: 1988-07-01 至 1997-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2220027
• 关键词: angiocardiography; angiocardioultrasonography; biomedical equipment development; computer assisted patient care; computer program /software; coronary bypass; dogs; esophagus; general anesthesia; heart disorder diagnosis; heart function; heart imaging /visualization /scanning; heart pharmacology; heart surgery; heart ventricle; human subject; indicator dilution test; microelectrodes; patient monitoring device; radionuclide imaging /scanning

The goal of the proposed research is to develop a 3-dimensional scanning biplane transesophageal echo (3D TEE) probe to measure left ventricular (LV) function during surgery, to validate the accuracy of quantitative analysis of regional and global function in 3-dimensions using this probe, and to investigate the suitability of such derived measures in outcome investigations in coronary artery or related surgery. We have demonstrated the feasibility of 3D multiplanar TEE interrogation of the LV during surgery in both animal and man. Global end diastolic (EDV) and end systolic (ESV) volumes, stroke volume, and ejection fraction (EF) measurements were shown in animals to be sufficiently accurate to supplant current clinical techniques. We developed a method for measuring regional EF from 3D reconstructions where computations are portrayed as histograms and/or color-coded 3D reconstructions. Cardiac surgery patients were studied, of whom 15/23 had regional akinesis and 8/23 normal function. The 3D TEE histograms agreed with contrast ventriculography 82% of the time. Of the 18% discrepancy, 82% of it was due to improper imaging of the basal or apical areas. Due in part to uncertainty in aligning 3D reconstructions to ventriculogram orientations, regional comparisons of the EF color-coded reconstructions gave lower agreement except in the apical regions for long axis scans (agreement - 83%). Although preliminary, the potential for quantitative 3D analysis is evident. However, the need for a probe that will scan the entire LV and a means of better orientation for comparative studies is also clear. Consequently, we propose to develop a new biplane probe which overcomes these current limitations. We will add to our interrogation and analysis the study of the epicardium and develop a method for correcting for heart translocation. An animal coronary artery occlusion model will be used to test the accuracy and diagnostic sensitivity of global and regional LV function measurement. The normal mean and standard deviation for regional LV assessment by our method will be defined from the data of patients with a low probability of heart disease who are undergoing orthopedic or gynecological surgery. Repeatability, accuracy and precision of measures will be investigated during cardiac surgery and postoperative recovery in the intensive care unit. Finally we will investigate whether we can detect changes in myocardial performance, before and after surgery, in regions receiving grafts. Of particular interest will be to learn if we can identify regions of the myocardium that may be stunned or hibernating.

该研究的目标是开发一种三维扫描 双平面经食管超声（3D TEE）探头，用于测量左心室 (LV)功能，以验证定量的准确性 使用该探针在3维中分析区域和全局功能， 并调查这些衍生措施在结果中的适用性 冠状动脉检查或相关手术。 我们已经证明了3D多平面TEE询问的可行性， 左心室在手术过程中在动物和人。整体舒张末期（EDV） 和收缩末期（ESV）容积、每搏输出量和射血分数（EF） 在动物中的测量结果显示足够准确， 目前的临床技术。 我们开发了一种方法， 来自3D重建的EF，其中计算被描绘为直方图 和/或颜色编码的3D重建。 心脏手术患者 其中15/23例有区域性运动不能，8/23例功能正常。 的 3D TEE直方图与对比心室造影82%的时间一致。 在18%的差异中，82%是由于基底节成像不当所致 或顶端区域。 部分原因是对齐3D重建时的不确定性 到心室造影方向，EF彩色编码的区域比较 重建得到较低的一致性，除了在顶端区域长 轴扫描（一致性- 83%）。 虽然是初步的， 3D定量分析是显而易见的。 然而，需要一种探测器， 将扫描整个LV和更好的定位方法，以进行比较 研究也很清楚。 因此，我们建议开发一种新的双平面探头， 这些目前的局限性。 我们会在审讯和分析中 研究心外膜并开发心脏矫正方法 易位 将使用动物冠状动脉闭塞模型来 测试全局和局部LV的准确性和诊断灵敏度 功能测量区域的正态均值和标准差 通过我们的方法进行的LV评估将根据以下患者的数据定义： 正在接受整形外科手术的心脏病患者患心脏病的概率较低， 妇科手术 测量的重复性、准确度和精密度 将在心脏手术和术后恢复期间进行研究， 重症监护室 最后，我们将研究我们是否可以检测到 手术前后心肌性能的变化， 接受移植 特别感兴趣的是，如果我们能 识别心肌中可能发生休克或冬眠的区域。