Vasilyev Nikolay V, Martinez Joseph F, Freudenthal Franz P, Suematsu Yoshihiro, Marx Gerald R, del Nido Pedro J
Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 2006 Oct;82(4):1322-6; discussion 1326. doi: 10.1016/j.athoracsur.2006.05.002.
Current real-time three-dimensional echocardiography systems (RT3DE) can provide sufficient visualization to permit atrial septal defect (ASD) closure. However, detailed visualization of small objects inside the heart is still suboptimal because of limited resolution, which is a limitation for clinical application. We evaluate the complementary use of videocardioscopy in image-guided ASD closure.
In a pig model (n = 5), a 4-mm to 8-mm ASD was created with RT3DE guidance. Defect closure was accomplished with a catheter-based patch-delivery system fixed around the defect with mini-anchors under combined RT3DE and videocardioscopy guidance. The endoscope was inserted into the heart through a custom built port designed to allow visualization in the presence of blood.
All ASDs were successfully closed. The combination of RT3DE and videocardioscopy allowed detailed visualization of intracardiac structures, instruments, patch, and mini-anchors.
Beating-heart ASD closure can be achieved with combined RT3DE and videocardioscopy imaging. Use of videocardioscopy provides high-resolution imaging and likely improves safety of the image-guided procedure.
当前的实时三维超声心动图系统（RT3DE）能够提供足够的可视化效果以允许进行房间隔缺损（ASD）封堵。然而，由于分辨率有限，心脏内部小物体的详细可视化效果仍不尽人意，这是临床应用中的一个限制。我们评估了视频心内直视镜在图像引导下ASD封堵中的辅助应用。
在猪模型（n = 5）中，在RT3DE引导下制造4毫米至8毫米的ASD。在RT3DE和视频心内直视镜联合引导下，使用基于导管的补片输送系统，通过微型锚定器将其固定在缺损周围来完成缺损封堵。通过一个定制的端口将内窥镜插入心脏，该端口设计用于在有血液的情况下进行可视化。
所有ASD均成功封堵。RT3DE和视频心内直视镜的结合使心脏内结构、器械、补片和微型锚定器得以详细可视化。
联合使用RT3DE和视频心内直视镜成像可实现跳动心脏的ASD封堵。视频心内直视镜的使用提供了高分辨率成像，并可能提高图像引导手术的安全性。
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