Sudhir K, Fitzgerald P J, MacGregor J S, DeMarco T, Ports T A, Chatterjee K, Yock P G
Cardiovascular Research Institute, University of California, San Francisco 94143-0124.
Circulation. 1991 Nov;84(5):1957-61. doi: 10.1161/01.cir.84.5.1957.
Catheter-based ultrasound is a new imaging modality to examine endovascular detail in the coronary circulation. This technique requires direct placement of the catheter in the arterial segment of interest.
We examined the feasibility of a less invasive approach by imaging the coronary arterial circulation by using a 5F (30 MHz) imaging catheter placed in the cardiac venous system. Using simultaneous fluoroscopy, we studied anesthetized closed-chest dogs (n = 6) and human subjects undergoing right heart catheterization (n = 11). After cannulation of the coronary sinus, the circumflex coronary artery (Cx) was visualized from the great cardiac vein (GCV), and on advancing the catheter into the anterior interventricular vein (AIV), the left anterior descending artery (LAD) was identified. Where artery and vein were parallel to each other, circular cross-sectional images of the coronary artery were obtained, whereas oblique and transverse orientation of artery to vein produced ellipsoid images or long-axis images. In the dogs, ultrasound-determined cross-sectional area of the coronary arteries (4.81 +/- 0.18 mm2) correlated closely with angiography (4.77 +/- 0.21 mm2) (r = 0.91, p less than 0.001). In humans, the Cx was readily visualized from the GCV in all subjects but because of anatomic variability, the LAD was seen less consistently from the AIV (73%). There was significant correlation between ultrasound-determined cross-sectional areas of the coronary arteries (8.25 +/- 0.34 mm2) with those from angiography (8.59 +/- 0.3 mm2) (r = 0.82, p = 0.001) in humans. In all subjects, the ultrasound transducer could be safely advanced into the AIV to the cardiac apex. Limitations of the technique include ultrasonic penetration problems, caused in part by the large size of human coronary veins and variability in artery-vein relations.
We conclude that transvenous imaging of coronary arteries with intravascular ultrasound is a less invasive, promising new approach to the study of structure and morphology in the coronary vasculature.
基于导管的超声是一种用于检查冠状动脉循环血管内细节的新型成像方式。该技术需要将导管直接放置在感兴趣的动脉节段。
我们通过将一根5F（30MHz）成像导管置于心脏静脉系统来对冠状动脉循环进行成像，以此检验一种侵入性较小的方法的可行性。利用同步荧光透视法，我们研究了麻醉状态下的开胸犬（n = 6）和接受右心导管检查的人类受试者（n = 11）。在插入冠状窦后，从大心静脉（GCV）可观察到左旋冠状动脉（Cx），当将导管推进到前室间静脉（AIV）时，可识别出左前降支动脉（LAD）。当动脉和静脉相互平行时，可获得冠状动脉的圆形横截面图像，而动脉与静脉呈斜向和横向时则产生椭圆形图像或长轴图像。在犬类中，超声测定的冠状动脉横截面积（4.81±0.18mm²）与血管造影结果（4.77±0.21mm²）密切相关（r = 0.91，p＜0.001）。在人类中，所有受试者均可从GCV轻松观察到Cx，但由于解剖变异，从AIV观察到LAD的一致性较差（73%）。在人类中，超声测定的冠状动脉横截面积（8.25±0.34mm²）与血管造影结果（8.59±0.3mm²）之间存在显著相关性（r = 0.82，p = 0.001）。在所有受试者中，超声换能器均可安全地推进到AIV直至心尖。该技术的局限性包括超声穿透问题，部分原因是人类冠状静脉尺寸较大以及动静脉关系的变异性。
我们得出结论，血管内超声经静脉成像冠状动脉是一种侵入性较小、有前景的研究冠状动脉血管结构和形态的新方法。
