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

本研究的主要目的是首先开发一种新的经食管超声心动图（TEE）成像的三维和四维（3D/4D）重建系统，其次评估其在指导心血管手术中的应用价值。1992年（第一年），我们的原型系统设计如下：(1)用手动回拉法依次获得原始TEE图像。(2) VTR记录2个心动周期。(3)利用帧记忆进行三维重建，并将三维图像与心电同步再现搏动三维（4D）。作为初步的临床经验，我们将该系统应用于14例患者（8例主动脉瘤和6例二尖瓣脱垂）。第一年的结果总结如下：(1)14例患者均成功获得TEE图像的3D/4D重建，正确成像病理，三维认识深入，三维结构内观清晰。(2)使用便宜的计算机，平均耗时3小时以上。1993年（第二年），为了提高3D/4D图像的图像质量，修改了检测初始表面的算法，并引入了半自动回拉扫描仪，缩短了处理时间。TEE换能器与食管粘膜之间接触不良，导致原始信号丢失，导致近三分之一使用该系统检查的患者3D/4D图像质量较差。1994年（第三年），为了获取原始信号，使用旋转方法来最小化原始信号的丢失，从而获得更好的3D/4D图像质量。3D/4D重建技术也应用于血管内和心内回声。第3年的结果总结如下：(1)TEE的3D/4D重建在主动脉夹层和二尖瓣修复手术中特别有用。(2)旋转法的3D/4D图像质量高于拉砖法。(3)血管内和心内回声的3D/4D图像在ASD/VSD关闭的主动脉瓣手术和导管介入治疗中具有外科价值。综上所述，新开发的三维/四维重建系统，如果数据处理时间可以足够缩短，可以作为未来手术室的诊断工具，特别是指导心血管手术的程序设计和模拟手术。少

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