scholarly journals B-PO04-068 ESOPHAGUS-TO-POSTERIOR ATRIAL WALL RELATIONSHIP: PRE- AND INTRA-PROCEDURAL THREE-DIMENSIONAL MULTIMODALITY IMAGING FOR ESOPHAGEAL POSITION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S306
Author(s):  
Cheryl Teres ◽  
David Soto-Iglesias ◽  
Diego Penela ◽  
Beatriz Jauregui ◽  
Alfredo Chauca ◽  
...  
Keyword(s):  
Multimodality Imaging ◽  
Three Dimensional ◽  
Atrial Wall

scholarly journals Esophagus-to-posterior Atrial wall relationship: pre- and Intra-procedural three-dimensional multimodality imaging for esophageal position

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
C Teres ◽  
D Soto-Iglesias ◽  
D Penela ◽  
B Jauregui ◽  
A Chauca ◽  
...  
Keyword(s):  
Multimodality Imaging ◽  
Three Dimensional ◽  
Heart Rhythm ◽  
Posterior Wall ◽  
Atrial Wall ◽  
Research Fellowship ◽  
Funding Sources ◽  
Semiautomatic Segmentation ◽  
Group I ◽  
The Stability

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Dr Teres was funded by the research fellowship grant of the Swiss Heart Rhythm Foundation. Dr Carreno-Lineros was funded by a Scholarship from Sociedad Española de Cardiología (SEC). Introduction   pulmonary vein isolation (PVI) approach implies unavoidable ablation  on the posterior atrial wall which is closely related to the esophagus. PVI may result in several complications. Objective the present study aims to analyze the stability of the esophageal position inside the mediastinum at the level of the posterior atrial wall from one procedure to another (Redo group) and during a single procedure (multi-image group). Methods the esophageal position was compared in two groups. First, pre-procedural multidetector computerized tomography (MDCTs) of the first PVI and the redo intervention (Redo group) were segmented with ADAS 3D™ software to compare the esophageal position and the atrio-esophageal distance prints (Figure A). Second, three imaging modalities were compared for the same procedure (multi-image group): i) preprocedural MDCT; ii) intraprocedural fluoroscopy obtained with the TEE probe in place in three projections with CARTOUNIVU™ (Biosense Webster); and iii) esophageal fast-anatomical map (FAM) obtained at the end of the procedure (Figure D). Ablation procedures were performed under general anesthesia. Exclusion criteria were unavailability or contraindication to obtain any of the techniques. The 3D correlation of the esophageal position acquired with different techniques, was computed in Matlab using semiautomatic segmentation analysis. Results 35 patients were analyzed for the Redo group. Mean age 61 ± 10 years, 17 (65%) male, mean LVEF 57 ± 7%, mean LA diameter 43 ± 5 mm, median time since previous ablation (and therefore between MDCT acquisitions) was 6 months (IQR 3-9). Mean atrio-esophageal distance for both MDCTs was 1.2 ± 0.6 mm . The esophageal trajectory as related to the atrial posterior wall was left for 20 (57%) patients, central for 6 (18%) patients, and right for 3 (9%) patients, left-central for 4 (11%) patients, and right-central for 2 (5%) patients. There was a 91 ± 5% correlation on the esophageal position between the first procedure and the redo procedure MDCT. In 3 cases the position was clearly different with a correlation of only 40 ± 22%. The multi-imaging group was composed of 100 patients, mean age 61 ± 10 years, 17 (65%) male, mean LVEF 56 ± 7%, mean LA diameter 39 ± 6 mm. The esophageal trajectory as related to the atrial posterior wall was left for 55 (55%) patients, central for 23 (23%) patients, and right for 9 (9%) patients, left-central for 8 (8%) patients, and right-central for 5 (5%) patients. The correlation between MDCT and CARTOUNIVU™ was 82 ± 10% (Figure B); between MDCT and ESOFAM 80 ± 12% (Figure B); and between ESOFAM and CARTOUNIVU™ 83 ± 15% (Figure C). Conclusions There is a high stability of the esophageal position between procedures and from the beginning to the end of procedure. This observation needs to be tested for its clinical utility by designing studies that take into account the esophagus distance print to modulate RF delivery Abstract Figure. Multimodal Esophageal imaging

Multimodality imaging anatomy of interatrial septum and mitral annulus

Heart ◽  
2020 ◽  
pp. heartjnl-2020-318127
Author(s):  
Francesco Fulvio Faletra ◽  
Laura Anna Leo ◽  
Vera Paiocchi ◽  
Susanne Schlossbauer ◽  
Jagat Narula ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Multimodality Imaging ◽  
Three Dimensional ◽  
Mitral Annulus ◽  
Ventricular Myocardium ◽  
Interatrial Septum ◽  
Atrial Septal Defect Closure ◽  
Hinge Line ◽  
Septum Primum ◽  
Contraction And Relaxation

The detailed anatomy of the interatrial septum (IAS) and mitral annulus (MA) as observed on cardiac magnetic resonance, computed tomography and two-dimensional/three-dimensional transthoracic and transesophageal echocardiography is reviewed. The IAS comprises of two components: the septum primum that is membrane-like forming the floor of the fossa ovalis (FO) and the septum secundum that is a muscular rim that surrounds the FO. The latter is an enfolding of atrial wall forming an interatrial groove. Named Waterston’s groove, it is filled with adipose tissue on the epicardial side. Thus, the safest area for transseptal puncture (TSP) is within the limits of the FO floor, which provides direct interatrial access. While crossing an intact septum is a well-established procedure, TSP is a more complex and time-consuming procedure in the presence of patent foramen ovalis, aneurysmal FO or atrial septal defect closure devices. MA comprises two distinctive segments: an anterior-straight and a posterior-curved segment. The posterior MA is a thin, discontinuous fibrous ‘string’, interspersed with adipose tissue, where four components converge: the atrial and ventricular musculature, epicardial adipose tissue and the leaflet’s hinge line. In parts of where this fibrous string is deficient or absent, the posterior leaflet is inserted directly on ventricular and atrial myocardium rendering the MA less robust and producing an ‘asymmetric’ dilation. The marked vulnerability of posterior MA to calcifications might be due to its insertion on the crest of ventricular myocardium being subject to friction injury due to the contraction and relaxation of LV.

scholarly journals The role of 3D echocardiographic imaging in the differential diagnosis of an atypical left atrial myxoma

2018 ◽  
Vol 88 (3) ◽  
Author(s):  
Domenico Galzerano ◽  
Claudio Pragliola ◽  
Mohamed Al Admawi ◽  
Mario Mallardo ◽  
Sara Di Michele ◽  
...  
Keyword(s):  
Left Atrial ◽  
Multimodality Imaging ◽  
Three Dimensional ◽  
Interatrial Septum ◽  
Atrial Myxoma ◽  
Anatomical Features ◽  
Left Atrial Myxoma ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

We describe a case of a left atrial myxoma atypical for its anatomical features and site of attachment. Although an initial multimodality imaging was performed, the diagnosis of myxoma was possible only by three dimensional echocardiography (3DE) which was able to identify the pedicle and the attachment at the base of the interatrial septum, close to the origin of right inferior pulmonary vein. In fact the 3DE can electronically section the structures and obtain unique planes useful in visualizing correctly the anatomical features of the myxomas and as a result, it facilitates the surgical decision planning. Even the anatomical appearance was uncommon at surgery and the diagnosis could be confirmed only by pathology.  This case highlights the diagnostic ability of the 3DE in similar challenging scenarios. 

scholarly journals Three-dimensional atrial wall thickness maps to inform catheter ablation procedures for atrial fibrillation

EP Europace ◽  
2015 ◽  
Vol 18 (3) ◽  
pp. 376-383 ◽  
Author(s):  
Martin Bishop ◽  
Ronak Rajani ◽  
Gernot Plank ◽  
Nicholas Gaddum ◽  
Gerry Carr-White ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Wall Thickness ◽  
Three Dimensional ◽  
Atrial Wall

A Three-Dimensional Registration Method for MicroUS/MicroPET Multimodality Small-Animal Imaging

2007 ◽  
Vol 29 (3) ◽  
pp. 155-166 ◽  
Author(s):  
Ai-Ho Liao ◽  
Li-Yen Chen ◽  
Wen-Fang Cheng ◽  
Pai-Chi Li
Keyword(s):  
Image Registration ◽  
Structural Information ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Small Animal Imaging ◽  
Three Dimensional ◽  
Small Animal ◽  
Imaging Method ◽  
Registration Method ◽  
Animal Imaging

Small-animal models are used extensively in disease research, genomics research, drug development and developmental biology. The development of noninvasive small-animal imaging techniques with adequate spatial resolution and sensitivity is therefore of prime importance. In particular, multimodality small-animal imaging can provide complementary information. This paper presents a method for registering high-frequency ultrasonic (microUS) images with small-animal positron-emission tomography (microPET) images. Registration is performed using six external multimodality markers, each being a glass bead with a diameter of 0.43–0.60 mm, with 0.1 μl of [18F]FDG placed in each marker holder. A small-animal holder is used to transfer mice between the microPET and microUS systems. Multimodality imaging was performed on C57BL/6J black mice bearing WF-3 ovary cancer cells in the second week after tumor implantation and rigid-body image registration of the six markers was also performed. The average registration error was 0.31 mm when all six markers were used and increased as the number of markers decreased. After image registration, image segmentation and fusion are performed on the tumor. Our multimodality small-animal imaging method allows structural information from microUS to be combined with functional information from microPET, with the preliminary results showing it to be an effective tool for cancer research.

scholarly journals Pelvic Reconstruction With a Novel Three-Dimensional-Printed, Multimodality Imaging Based Endoprosthesis Following Enneking Type I + IV Resection

2021 ◽  
Vol 11 ◽  
Author(s):  
Zeping Yu ◽  
Wenli Zhang ◽  
Xiang Fang ◽  
Chongqi Tu ◽  
Hong Duan
Keyword(s):  
Multimodality Imaging ◽  
Three Dimensional ◽  
Patient Specific ◽  
Surgical Trauma ◽  
Type I ◽  
Complication Rates ◽  
Pelvic Tumor ◽  
Musculoskeletal Tumor Society ◽  
Rod System ◽  
3D Printed

Background and PurposePelvic tumor involving Type I + IV resections are technically challenging, along with various reconstructions methods presenting unsatisfactory outcomes and high complication rates. Since predominating studies preferred adopting pedicle screw-rod system (PRSS) to address this issue, we designed a novel three-dimensional-printed, multimodality imaging (3DMMI) based endoprosthesis with patient-specific instrument (PSI) assistance to facilitate the surgical reconstruction of pelvic tumor involving Enneking Type I + IV resection. We aimed to investigate the clinical effectiveness of this novel endoprosthesis and compare it with PRSS in Type I + IV reconstruction.MethodsWe retrospective studied 28 patients for a median follow-up of 47 months (range, 10 to 128 months) in this study with either 3D-printed endoprosthesis reconstruction (n = 10) or PRSS reconstruction (n = 18) between January 2000 and December 2017. Preoperative 3DMMI technique was used for tumor evaluation, PSI design, virtual surgery, and endoprosthesis fabrication. Clinical, oncological outcomes, functional assessments, and complications were analyzed between the two groups.ResultsMinor surgical trauma with mean operative duration of 251 ± 52.16 minutes (p = 0.034) and median intraoperative hemorrhage of 2000ml (range, 1600, 4000ml) (p = 0.032) was observed in endoprosthesis group. Wide margins were achieved in 9 patients of the endoprosthesis group compared with 10 in the PRSS group (p = 0.09). The 1993 version of the Musculoskeletal Tumor Society score (MSTS-93) was 23.9 ± 3.76 in endoprosthesis group, which was higher than PRSS group (p = 0.012). No statistical significance was found in relapse between two groups (p = 0.36). Complications were observed in two patients in endoprosthesis group compared with 12 patients in PRSS group (p = 0.046).ConclusionThe novel design of this 3D-printed endoprosthesis, together with 3DMMI and PSI assisted, is technically accessible with favorable clinical outcomes compared with PRSS. Further study is essential to identify its long-term outcomes.

scholarly journals Case Report: Severe Aortic Valve Regurgitation and Pseudoaneurysm in Aortic Valve-Sparing Operation: The Usefulness of Multimodality Imaging in a Complex Clinical Scenario

2021 ◽  
Vol 8 ◽  
Author(s):  
Leonardo Varotto ◽  
Luca Spigolon ◽  
Alberto Dotto ◽  
Valentina Siviero ◽  
Marta Scodro ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Multimodality Imaging ◽  
Three Dimensional ◽  
3D Ultrasound ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Aortic Pseudoaneurysm ◽  
Complex Anatomy ◽  
Valve Sparing

Background: Failure of the native aortic valve and degenerative anatomy of ascending aorta in patients with previous Tirone-David operation may represent a clinical challenge, because sometimes the risk of reoperation is prohibitive.Case: We described the case of a patient suffering from severe aortic valve regurgitation and pseudoaneurysm of the aortic arch, 6 years after cardiac surgery operation. The aim of this clinical case was to assess if the complex anatomy of aortic pseudoaneurysm and aortic root geometry can be accurately reproduced from contrast-enhanced computed tomography scan into a three-dimensional (3D) printed model. Based on this procedural method, with the aid of transesophageal 3D ultrasound, we efficaciously treated the patient percutaneously with a combination of transcatheter occluder device plus microcoil embolization and transfemoral aortic valve implantation. The patient was free from complications and the need to redo cardiac surgery.Conclusion: To the best of our knowledge, this is the first description of two simultaneous complications and their staged treatment in a patient with previous aortic valve-sparing operation. This is a useful report in a single 3D model applying such specific technology to these two simultaneous clinical settings.

scholarly journals Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19

2020 ◽  
Author(s):  
Paraskevi Theocharis ◽  
James Wong ◽  
Kuberan Pushparajah ◽  
Sujeev K Mathur ◽  
John M Simpson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Multimodality Imaging ◽  
Cardiac Computed Tomography ◽  
Three Dimensional ◽  
Cardiovascular Effects ◽  
Tissue Doppler ◽  
Valvular Regurgitation ◽  
Close Monitoring ◽  
Myocardial Oedema ◽  
Coronary Artery Dilatation

Abstract Aims Following the peak of the UK COVID-19 epidemic, a new multisystem inflammatory condition with significant cardiovascular effects emerged in young people. We utilized multimodality imaging to provide a detailed sequential description of the cardiac involvement. Methods and Results Twenty consecutive patients (mean age 10.6 ± 3.8 years) presenting to our institution underwent serial echocardiographic evaluation on admission (median day 5 of illness), the day coinciding with worst cardiac function (median day 7), and the day of discharge (median day 15). We performed cardiac computed tomography (CT) to assess coronary anatomy (median day 15) and cardiac magnetic resonance imaging (CMR) to assess dysfunction (median day 20). On admission, almost all patients displayed abnormal strain and tissue Doppler indices. Three-dimensional (3D) echocardiographic ejection fraction (EF) was <55% in half of the patients. Valvular regurgitation (75%) and small pericardial effusions (10%) were detected. Serial echocardiography demonstrated that the mean 3D EF deteriorated (54.7 ± 8.3% vs. 46.4 ± 8.6%, P = 0.017) before improving at discharge (P = 0.008). Left main coronary artery (LMCA) dimensions were significantly larger at discharge than at admission (Z score –0.11 ± 0.87 vs. 0.78 ± 1.23, P = 0.007). CT showed uniform coronary artery dilatation commonly affecting the LMCA (9/12). CMR detected abnormal strain in all patients with global dysfunction (EF <55%) in 35%, myocardial oedema in 50%, and subendocardial infarct in 5% (1/20) patients. Conclusions Pancarditis with cardiac dysfunction is common and associated with myocardial oedema. Patients require close monitoring due to coronary artery dilatation and the risk of thrombotic myocardial infarction.

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