scholarly journals The Value of 3D Printing Models of Left Atrial Appendage Using Real-Time 3D Transesophageal Echocardiographic Data in Left Atrial Appendage Occlusion: Applications toward an Era of Truly Personalized Medicine

Cardiology ◽  
2016 ◽  
Vol 135 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Peng Liu ◽  
Rijing Liu ◽  
Yan Zhang ◽  
Yingfeng Liu ◽  
Xiaoming Tang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
3D Printing ◽  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
3D Models ◽  
Atrial Appendage ◽  
Patient Specific ◽  
The Real ◽  
Echocardiographic Image

Aims and Objectives: The objective of this study was to assess the clinical feasibility of generating 3D printing models of left atrial appendage (LAA) using real-time 3D transesophageal echocardiogram (TEE) data for preoperative reference of LAA occlusion. Background: Percutaneous LAA occlusion can effectively prevent patients with atrial fibrillation from stroke. However, the anatomical structure of LAA is so complicated that adequate information of its structure is essential for successful LAA occlusion. Emerging 3D printing technology has the demonstrated potential to structure more accurately than conventional imaging modalities by creating tangible patient-specific models. Typically, 3D printing data sets are acquired from CT and MRI, which may involve intravenous contrast, sedation, and ionizing radiation. It has been reported that 3D models of LAA were successfully created by the data acquired from CT. However, 3D printing of the LAA using real-time 3D TEE data has not yet been explored. Methods: Acquisition of 3D transesophageal echocardiographic data from 8 patients with atrial fibrillation was performed using the Philips EPIQ7 ultrasound system. Raw echocardiographic image data were opened in Philips QLAB and converted to ‘Cartesian DICOM' format and imported into Mimics® software to create 3D models of LAA, which were printed using a rubber-like material. The printed 3D models were then used for preoperative reference and procedural simulation in LAA occlusion. Results: We successfully printed LAAs of 8 patients. Each LAA costs approximately CNY 800-1,000 and the total process takes 16-17 h. Seven of the 8 Watchman devices predicted by preprocedural 2D TEE images were of the same sizes as those placed in the real operation. Interestingly, 3D printing models were highly reflective of the shape and size of LAAs, and all device sizes predicted by the 3D printing model were fully consistent with those placed in the real operation. Also, the 3D printed model could predict operating difficulty and the presence of a peridevice leak. Conclusions: 3D printing of the LAA using real-time 3D transesophageal echocardiographic data has a perfect and rapid application in LAA occlusion to assist with physician planning and decision making.

P2467Fusion imaging (Anatomical Intelligence) enables automated left atrial appendage sizing in real-time a single center pilot study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Afzal ◽  
V Veulemans ◽  
K Hellhammer ◽  
K Piayda ◽  
N Nijhof ◽  
...  
Keyword(s):  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Fusion Imaging ◽  
Atrial Appendage ◽  
Patient Specific ◽  
Heart Model ◽  
Landing Zone ◽  
Device Selection ◽  
The Mean

Abstract Background and purpose Percutaneous left atrial appendage occlusion (LAAO) depicts an alternative treatment for patients with atrial fibrillation who are deemed for long-term oral anticoagulation therapy. In order to perform a successful LAAO accurate sizing of left atrial appendage (ostium, landing zone and depth) for device selection is essential. Echo-Fluoro fusion imaging in real-time offers with its latest prototype a patient-specific segmented automated 3D heart model and sizing of left atrial appendage (LAA). We therefore aimed to evaluate the automated segmented LAA sizing by comparing to 2D transesophageal (TOE) and MSCT measurements as gold standard. Methods We studied prospectively data of 8 consecutive patients who were admitted to our clinic for left atrial appendage closure. MSCT was performed preprocedural and analyzed with commercially available 3mensio software (Pie medical imaging). 2D TOE measurements and automated segmentation of the LAA and sizing were performed during the procedure by a highly experienced team of periinterventional cardiac imaging specialist and structural heart disease interventionalist who were blinded to the prior MSCT analysis. Dimension of ostium, landing zone (10 mm into the LAA parallel to the ostial plane at the level of the left circumflex for Amplatzer device) and depth (perpendicular to the ostial plane) were obtained in different TOE views according to instructions for use of Amulet Occluder. In order to generate an automated 3 D heart model, a high-quality 3D TOE image of the LAA volume and surrounding structures was acquired. After successful ECG-gated segmentation a 3 D heart model was generated. Automated LAA sizing followed in real-time. All measurements were taken into consideration before device selection. A Kruskal Wallis test was used to compare mean ranks of independent samples. A concordance analysis according to Kendall W was carried out to investigate reliability. Results The mean age of the patients was 82,6±4.15 years and half of the patients were female. All procedures were conducted successfully. The mean values of ostium and landing zone were comparable in TOE, automated sizing and MSCT sizing (ostium: 23,78±2,15 mm vs 25,71±5,25 mm vs 27,35±3,3 mm; (p=0,175); landing zone 22,13±3,18 mm vs 23,57±3,31 mm vs 24,00±3,51 mm; (p=0,377)). Furthermore, a significant concordance between the measurements was shown (ostium W= 0,991; p=0.045, landing zone W=0,835, p=0.014). Conclusion Automated LAA sizing acquired by fusion imaging may be an elegant real-time alternative for precise LAA Occluder device selection and needs to be investigated further.

Abstract 13097: Feasibility and Safety of Trans-nasal Transesophageal Echocardiography Guiding Left Atrial Appendage Closure Without General Anesthesia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mingxing XIE ◽  
Sun Wei ◽  
Wang Bin ◽  
He Liin ◽  
Lv Qing ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Local Anesthesia ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Alternative Therapy ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
The Real

Background: Percutaneous left atrial appendage closure (LAAO), may be an alternative therapy to non-valvular atrial fibrillation (AF) patients. And the transesophageal echocardiography (TEE) is the mainstay of the imaging technology to guide LAAO procedures. However, in the local anesthesia state, LAAO cannot be accomplished under the real-time guidance of conventional TEE with the standard adult TEE probe. The aim of the study was to explore the feasibility and safety of trans-nasal TEE with the microprobe to guide LAAO without general anesthesia. Methods: A total of 30 non-valvular AF participants were enrolled in the study. All participants both underwent conventional TEE examination with the standard adult TEE probe before LAAO, and the real-time guidance of trans-nasal TEE with the microprobe intraoperatively under local anesthesia. Results: There weren’t significant difficulties to insert the microprobe into the esophagus through the nares. All patients tolerated the trans-nasal approach well. Image quality by the microprobe was reviewed as good (67.3%) and acceptable (36.7%) by two different echocardiographers. The devices were successfully implanted in all participants. No observed significant residual peri-device leaks by the microprobe at the time of the procedure and by the standard TEE on a median of 55 days (interquartile range: 48 to 66 days) postoperatively. 2(7%) patients had mild epistaxis after the procedure, and there were no other severe complications. Conclusion: The present study preliminarily showed the feasibility and safety of the trans-nasal micro-TEE and suggested it may become an alternative to conventional TEE to guide LAAO procedure without general anesthesia.

scholarly journals Real-Time Pathophysiologic Correlates of Left Atrial Appendage Thrombus in Patients Who Underwent Transesophageal-Guided Electrical Cardioversion for Atrial Fibrillation

2018 ◽  
Vol 121 (12) ◽  
pp. 1540-1547 ◽  
Author(s):  
Rowlens M. Melduni ◽  
Bernard J. Gersh ◽  
Waldemar E. Wysokinski ◽  
Naser M. Ammash ◽  
Paul A. Friedman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Electrical Cardioversion ◽  
Atrial Appendage ◽  
Left Atrial Appendage Thrombus

Endocardial left atrial appendage occlusion in atrial fibrillation: computational fluid dynamics simulations to assess stroke risk

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Masci ◽  
N D"alessandro ◽  
A Scivoletto ◽  
S Severi ◽  
F Ansaloni ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Atrial Fibrillation ◽  
Computational Fluid Dynamics ◽  
Blood Flow ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Blood Stasis ◽  
Atrial Appendage ◽  
Patient Specific ◽  
Hemodynamic Changes

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous endocardial left atrial appendage (LAA) occlusion (LAAO) in non-valvular atrial fibrillation (AF) seems comparable to anticoagulation therapy (OAC) as regards thromboembolic risk reduction with a possible additional decrease in major bleeding. LAAO is currently limited to patients with contraindications to OAC, due to its high costs and procedural risks, but better pre-procedural planning and operative techniques might improve the outcome widening practical indications. Computational fluid dynamics (CFD) represents a valuable non-invasive approach to estimate physiologically significant hemodynamic parameters in a complex fluid dynamics system. It might provide a helpful in silico simulation of blood flow patterns within the LA and LAA by using 3D patient-specific models, allowing LAAO planning and effects prediction. Purpose This study’s aim was to simulate the fluid dynamics effects of LAAO in AF patients to predict patient-specific hemodynamic changes caused by applying the two most popular devices. Methods LAAO was simulated on the 3D LA anatomical models obtained from CT data in 5 AF patients, considering the device specific shape. CFD simulations in AF condition were performed both on the whole LA model and on the models with the LAAO performed with the two devices. Significant fluid dynamics indices (blood velocity, vortex structures, LAA ostium velocity, LA blood stasis) were computed to evaluate the changes in the flow patterns after LAAO in relation to the thrombogenic risk. Results Overall we found a more effective washout within the LA after LAAO, in terms of a different spatial distribution of velocities (see figure for a qualitative evaluation of LA blood flow velocity in one patient: (A) model with LA and LAA; models after LAAO applying the Amulet (B) and the Watchman (C) device) and vortex structures (after LAAO, they were decreased in number and increased in size). Moreover, a higher velocity at the mitral valve and at the LAA ostium (peak velocity: 12-17 cm/s in the models with LAA, 40-60 cm/s in LAAO_A and 35-65 in LAAO_W) was detected together with  a slightly improved washout effect in terms of blood stasis with the Watchman device (stasis: 3.1-5.7% in the models with LAA, 1.9-4.1% in LAAO_A, 1.7-3.7% in LAAO_W). Conclusions A workflow for simulating the fluid dynamics effects of endocardial LAAO in AF was developed and tested. CFD provides a valuable tool to quantify hemodynamic changes after LAAO and assess thrombogenic risk in patient-specific LA and LAA. Our preliminary results suggest that endocardial LAAO favourably affects blood fluid dynamics in the LA. Abstract figure

Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography

2016 ◽  
Vol 33 (4) ◽  
pp. 491-498 ◽  
Author(s):  
Ilaria Dentamaro ◽  
Domenico Vestito ◽  
Ennio Michelotto ◽  
Delia De Santis ◽  
Vittoria Ostuni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
3D Transesophageal Echocardiography
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