Szili-Torok T, Kimman G P, Theuns D, Res J, Roelandt J R T C, Jordaens L J
Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.
Eur J Echocardiogr. 2003 Mar;4(1):17-22. doi: 10.1053/euje.2002.0169.
Fluoroscopy does not allow identification specific anatomical landmarks during electrophysiological studies. Intra-cardiac echocardiography permits visualization of these structures with excellent accuracy, but the optimal method has not been fully described. The aim of this study was to assess the capability of intra-cardiac echocardiography for the visualization of such structures using two different approaches. We also assessed its capability for the evaluation of radio frequency lesions 20 min after catheter ablation of the cavo-tricuspid isthmus.
Intra-cardiac echocardiography was performed using a 9 MHz rotating transducer in eight consecutive patients (age range: 37-76 years) after radio frequency ablation of the cavo-tricuspid isthmus. The ultrasound catheter was inserted through the femoral vein into the superior vena cava and was pulled back to the inferior vena cava. The echo catheter was then reinserted through the subclavian vein and advanced into the right ventricular apex and was pulled back from the right ventricular to the superior vena cava. Qualitative evaluation and intra-cardiac measurements were performed off-line.
The fossa ovalis, the tricuspid valve, and the terminal crest were visible in all patients regardless of the method of introduction of the echo catheter. Left-sided structures were less accurately seen by intra-cardiac echocardiography. The horizontal diameter of the fossa ovalis was 8.9+/-1.8mm. The cavo-tricuspid isthmus was visible using the femoral approach in three patients. The isthmus could be visualized in all patients, and in three patients together with the ostium of the coronary sinus, using the subclavian approach. radio frequency lesions were not visible 20 min after ablation. Additionally, both the left and right ventricles could be seen using the subclavian approach.
The subclavian approach is feasible, safe and superior to visualize the isthmus. Twenty minutes after radio frequency ablation of the cavo-tricuspid isthmus radio frequency lesions are not visible using intra-cardiac echocardiography.
在电生理研究中，荧光镜检查无法识别特定的解剖标志。心内超声心动图能够以极高的准确性显示这些结构，但最佳方法尚未得到充分描述。本研究的目的是使用两种不同方法评估心内超声心动图显示此类结构的能力。我们还评估了在腔静脉 - 三尖瓣峡部导管消融术后20分钟，其评估射频消融灶的能力。
对8例连续患者（年龄范围：37 - 76岁）在腔静脉 - 三尖瓣峡部射频消融术后，使用9MHz旋转换能器进行心内超声心动图检查。超声导管经股静脉插入上腔静脉，然后回撤至下腔静脉。然后将超声导管经锁骨下静脉重新插入并推进至右心室心尖，再从右心室回撤至上腔静脉。定性评估和心内测量在离线状态下进行。
无论超声导管的引入方法如何，所有患者均可见卵圆窝、三尖瓣和终嵴。心内超声心动图对左侧结构的显示准确性较低。卵圆窝的水平直径为8.9±1.8mm。使用股静脉入路，3例患者可见腔静脉 - 三尖瓣峡部。使用锁骨下静脉入路，所有患者均可见峡部，3例患者还可见冠状窦口。消融术后20分钟，射频消融灶不可见。此外，使用锁骨下静脉入路可同时观察到左心室和右心室。
锁骨下静脉入路可行、安全，且在显示峡部方面更具优势。在腔静脉 - 三尖瓣峡部射频消融术后20分钟，心内超声心动图无法观察到射频消融灶。
