Ultrasound Tissue Erosion for Cardiac Applications

描述（由申请人提供）：本申请的主要目标是开发一种高度受控的无创超声手术，以机械细分和去除组织，主要用于心脏应用。正在开发的方法可以被认为是类似于软组织的碎石术。受控超声组织侵蚀（CUTE）过程与大多数软组织治疗性超声程序有根本不同，因为必须精确切除组织，而不是原位产生热坏死。其基本机制不同于产生热坏死的机制，需要充分阐明，以便合理优化侵蚀过程。这是该提案的总体目标。初步结果提出了以下机制假设，这些假设构成了本文提出的实验工作的基础。1. CUTE过程取决于启动的“气泡云”和超声辐照之间的合作相互作用，其中可以微调（优化）声学参数以最有效地使用传播的能量。必须通过适当调整声学参数，使初始气泡云保持在最佳状态。过去的暴露史可以预先决定未来最佳暴露的过程。脉冲超声波是最有效的方式来组织的insonation，以最佳地保持这一套复杂的合作现象。我们建议研究这些迷人的相互作用的声音和泡沫合奏，1。充分探索声学参数空间，寻求最佳参数以最大化传播能量的治疗效果;以及2.利用先进的光学和声学技术直接观测“气泡云”。如果我们能够充分理解这些合作过程，我们将能够更有效地优化特定临床应用的过程。受控超声组织侵蚀有望将碎石术的治疗原理扩展到所有（或大多数）软组织。应用范围远远超出心脏病学，尽管特定的心脏应用最有前途。

DESCRIPTION (provided by applicant): The primary goal of this application is to develop a highly controlled noninvasive ultrasound procedure to mechanically subdivide and remove tissue, primarily for cardiac applications. The method being developed can be thought of as analogous to lithotripsy for soft tissues. The Controlled Ultrasound Tissue Erosion (CUTE) process is fundamentally different from most soft tissue therapeutic ultrasound procedures in that tissue must be precisely removed instead of producing thermal necrosis in situ. The underlying mechanisms are different from those producing thermal necrosis and need to be fully elucidated so that the erosion process can be rationally optimized. This is the global aim of the proposal. Preliminary results suggest the following mechanistic hypotheses that form the basis of the experimental work proposed herein. 1. The CUTE process depends on co-operative interaction between an initiated "bubble cloud" and the ultrasound insonation where acoustic parameters can be finely tuned (optimized) for the most efficient use of propagated energy, 2. The initiated bubble cloud must be maintained in an optimal state by appropriate adjustment of acoustic parameters, 3. The past history of exposure can predispose the process for optimal future exposure, 4. Pulsed ultrasound is the most effective way to organize the insonation to optimally maintain this complex set of co-operative phenomena. We propose to study these fascinating interactions of sound and bubble ensembles by, 1. Fully exploring acoustic parameter space seeking optimal parameters to maximize therapeutic effects of the propagated energy; and 2. Observing directly the "bubble clouds" by sophisticated optical and acoustic techniques. If we can fully understand these co-operative processes, we will be ably to more effectively optimize the process for specific clinical application. Controlled Ultrasound Tissue Erosion promises to extend the therapeutic rationale of Lithotripsy to all (or most) soft tissues. The applications extend far beyond cardiology although specific cardiac applications are most promising.