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应用相控阵超声在体经食管心脏消融的可行性。

Feasibility of in vivo transesophageal cardiac ablation using a phased ultrasound array.

机构信息

Department of Dairy and Animal Science, The Pennsylvania State University, University Park, PA 16802, USA.

出版信息

Ultrasound Med Biol. 2010 May;36(5):752-60. doi: 10.1016/j.ultrasmedbio.2010.02.002. Epub 2010 Mar 28.


DOI:10.1016/j.ultrasmedbio.2010.02.002
PMID:20347517
Abstract

Over 2.2 million Americans suffer from atrial fibrillation making it one of the most common arrhythmias. Cardiac ablation has shown a high rate of success in treating paroxysmal atrial fibrillation. Prevailing modalities for this treatment are catheter based radio-frequency ablation or surgery. However, there is measurable morbidity and significant costs and time associated with these invasive procedures. Due to these issues, developing a method that is less invasive to treat atrial fibrillation is needed. In the development of such a device, a transesophageal ultrasound applicator for cardiac ablation was designed, constructed and evaluated. A goal of this research was to create lesions in myocardial tissue using a phased array. Based on multiple factors from array simulations, transesophageal imaging devices and throat anatomy, a phased ultrasound transducer that can be inserted into the esophagus was designed and tested. In this research, a two-dimensional sparse phased array with the aperture size of 20.7 mm x 10.2 mm with flat tapered elements as a transesophageal ultrasound applicator was fabricated and evaluated with in vivo experiments. Five pigs were anesthetized; the array was passed through the esophagus and positioned over the heart. The array was operated for 8-15 min at 1.6 MHz with the acoustic intensity of 150-300 W/cm(2) resulting in both single and multiple lesions on atrial and ventricular myocardium. The average size of lesions was 5.1 +/- 2.1 mm in diameter and 7.8 +/- 2.5 mm in length. Based on the experimental results, the array delivered sufficient power to the focal point to produce ablation while not grossly damaging nearby tissue outside the target area. These results demonstrate a potential application of the ultrasound applicator to transesophageal cardiac surgery in atrial fibrillation treatment.

摘要

超过 220 万美国人患有心房颤动,使其成为最常见的心律失常之一。心脏消融术已显示出治疗阵发性心房颤动的高成功率。这种治疗的主要方法是基于导管的射频消融或手术。然而,这些侵入性程序存在可衡量的发病率和显著的成本和时间。由于这些问题,需要开发一种对治疗心房颤动侵入性较小的方法。在开发这种设备的过程中,设计、构建和评估了一种用于心脏消融的经食管超声应用器。这项研究的目标之一是使用相控阵在心肌组织中产生病变。基于来自阵列模拟、经食管成像设备和喉咙解剖结构的多个因素,设计并测试了一种可以插入食管的相控超声换能器。在这项研究中,制造并评估了一种具有 20.7mm x 10.2mm 孔径尺寸的二维稀疏相控阵,其阵元为平面渐变锥形,作为经食管超声应用器。将阵列通过食管插入并放置在心脏上方。在 1.6MHz 下操作阵列 8-15 分钟,声强为 150-300W/cm(2),导致心房和心室心肌上产生单个和多个病变。病变的平均直径为 5.1 +/- 2.1mm,长度为 7.8 +/- 2.5mm。根据实验结果,该阵列将足够的功率传输到焦点,以产生消融效果,而不会严重损害目标区域外的附近组织。这些结果表明,超声应用器在经食管心脏手术中治疗心房颤动具有潜在的应用价值。

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Feasibility of in vivo transesophageal cardiac ablation using a phased ultrasound array.

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