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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Phased-array intracardiac echocardiography for guiding transseptal catheter placement: utility and learning curve.
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Phased-array intracardiac echocardiography for guiding transseptal catheter placement: utility and learning curve.

机译：相控阵心内超声心动图，用于指导跨间隔导管的放置：效用和学习曲线。

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摘要

The utility of a new intracardiac 64-element, phased-array, longitudinal ultrasound imaging system for guiding transseptal catheterization was assessed during 69 crossing attempts in 45 dogs because of the inherent limitations of fluoroscopy and mechanical ultrasound. Multifrequency (7.5-8.5 MHZ) imaging of the membranous fossa ovalis, posterior left atrium, and left atrial appendage was conducted from the right atrium. Contact of the Brockenbrough needle with the interatrial septum as reflected by membranous fossa ovalis "tenting" was uniformly identified. Transseptal crossing and advancement of the dilator and sheath were adequately imaged because of deeper ultrasound tissue penetration. Transseptal catheterization was successfully accomplished in 44 of 45 dogs: on the first attempt in 40 and with additional attempts in 4 and confirmed by direct far-field imaging of nonagitated saline injection via the sheath. Total transseptal catheterization time was 3.0 +/- 1.8 minutes. Unsuccessful first attempts and/or subsequent sheath pullback into the right atrium with catheter manipulation were also readily recognized. Insertion of the transseptal needle beyond the ultrasound imaging plane resulted in perforation of the posterior left atrial wall in three attempts. Accompanying effusions in these animals and three others related to subsequent intracardiac ablation catheter manipulation were readily identified and monitored echocardiographically. In conclusion, phased-array intracardiac imaging provides a highly reliable means of guiding transseptal access to the left atrium. In addition, inadvertent complications such as perforation and pericardial effusion development can be readily recognized.
机译：由于荧光检查和机械超声的固有局限性，在45只狗的69次穿刺尝试中，评估了一种新型的心内膜64元素相控阵纵向超声成像系统用于引导经隔导管的实用性。从右心房进行多频率（7.5-8.5 MHZ）成像的膜状卵圆窝，左后房和左心耳。一致地确定了Brockenbrough针与房间隔的接触，如膜状卵圆窝“帐篷”所反映。由于超声组织的穿透力较深，因此可以充分观察到扩张器和鞘管的跨隔交叉和进展情况。经隔隔导管插入术成功地完成了45只狗中的44只：第一次尝试40只，另外尝试4只，并通过对通过皮套注射不搅拌的盐水进行的远场直接成像证实了这一点。经隔膜的总导管插入时间为3.0 +/- 1.8分钟。还很容易识别出通过导管操作未成功进行的首次尝试和/或随后的护套拉回到右心房。在超声成像平面外插入后房间隔针会导致三次左心房壁穿孔。在这些动物中以及与随后进行的心脏内消融导管操作有关的其他三个动物中的伴随积液很容易被识别并通过超声心动图进行监测。总之，相控阵心内成像为引导经房间隔进入左心房提供了高度可靠的手段。此外，可以很容易地发现诸如穿孔和心包积液等疏忽的并发症。

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