1
|
Garg J, Kewcharoen J, Bhardwaj R, Contractor T, Jain S, Mandapati R. Intracardiac echocardiography from coronary sinus. J Cardiovasc Electrophysiol 2022; 33:2382-2388. [PMID: 36153661 PMCID: PMC9828028 DOI: 10.1111/jce.15687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/28/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023]
Abstract
Intracardiac echocardiography (ICE) has become an essential tool and is an integral part of percutaneous interventional and electrophysiology (EP) procedures. Intracardiac echocardiography offers real-time, high-quality, near-field evaluation of cardiac anatomy. Standard ICE imaging includes placing the catheter in the right atrium (RA), right ventricle (RV), or left atrium (LA, via the transeptal approach). Coronary sinus echocardiography (CSE) is another alternative, where the ICE catheter is positioned in the coronary sinus (CS). This approach offers better catheter stability and allows operators to visualize cardiac structure with particularly excellent views of the LA, LAA, left ventricle (LV), and mitral annulus. Additionally, CSE is an attractive alternative in cases with unfavorable interatrial septum or fossa ovalis anatomical features that could lead to difficulty advancing ICE catheter in left atrium. In this article focusing on CSE, we provide illustration-based guidance to help operators identify critical cardiac structures from CSE.
Collapse
Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Sarika Jain
- Division of Cardiothoracic SurgeryLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| |
Collapse
|
2
|
Enriquez A, Saenz LC, Rosso R, Silvestry FE, Callans D, Marchlinski FE, Garcia F. Use of Intracardiac Echocardiography in Interventional Cardiology: Working With the Anatomy Rather Than Fighting It. Circulation 2019; 137:2278-2294. [PMID: 29784681 DOI: 10.1161/circulationaha.117.031343] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The indications for catheter-based structural and electrophysiological procedures have recently expanded to more complex scenarios, in which an accurate definition of the variable individual cardiac anatomy is key to obtain optimal results. Intracardiac echocardiography (ICE) is a unique imaging modality able to provide high-resolution real-time visualization of cardiac structures, continuous monitoring of catheter location within the heart, and early recognition of procedural complications, such as pericardial effusion or thrombus formation. Additional benefits are excellent patient tolerance, reduction of fluoroscopy time, and lack of need for general anesthesia or a second operator. For these reasons, ICE has largely replaced transesophageal echocardiography as ideal imaging modality for guiding certain procedures, such as atrial septal defect closure and catheter ablation of cardiac arrhythmias, and has an emerging role in others, including mitral valvuloplasty, transcatheter aortic valve replacement, and left atrial appendage closure. In electrophysiology procedures, ICE allows integration of real-time images with electroanatomic maps; it has a role in assessment of arrhythmogenic substrate, and it is particularly useful for mapping structures that are not visualized by fluoroscopy, such as the interatrial or interventricular septum, papillary muscles, and intracavitary muscular ridges. Most recently, a three-dimensional (3D) volumetric ICE system has also been developed, with potential for greater anatomic information and a promising role in structural interventions. In this state-of-the-art review, we provide guidance on how to conduct a comprehensive ICE survey and summarize the main applications of ICE in a variety of structural and electrophysiology procedures.
Collapse
Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| | - Luis C Saenz
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia. Instituto de Cardiologia. Centro Internacional de Arritmias "Andrea Natale," Fundacion Cardioinfantil, Bogota, Colombia (L.C.S.)
| | - Raphael Rosso
- Cardiac Eletrophysiology, Cardiology Division, Tel-Aviv Souraski Medical Center, Israel (R.R.)
| | | | - David Callans
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| | | | - Fermin Garcia
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| |
Collapse
|
3
|
Bunting E, Papadacci C, Wan E, Sayseng V, Grondin J, Konofagou EE. Cardiac Lesion Mapping In Vivo Using Intracardiac Myocardial Elastography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:14-20. [PMID: 29283343 PMCID: PMC5747324 DOI: 10.1109/tuffc.2017.2768301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Radio frequency (RF) ablation of the myocardium is used to treat various cardiac arrhythmias. The size, spacing, and transmurality of lesions have been shown to affect the success of the ablation procedure; however, there is currently no method to directly image the size and formation of ablation lesions in real time. Intracardiac myocardial elastography (ME) has been previously used to image the decrease in cardiac strain during systole in the ablated region as a result of the lesion formation. However, the feasibility of imaging multiple lesions and identifying the presence of gaps between lesions has not yet been investigated. In this paper, RF ablation lesions ( ) were generated in the left ventricular epicardium in three anesthetized canines. Two sets of two lesions each were created in close proximity to one another with small gaps (1.5 and 4 cm), while one set of two lesions was created directly next to each other with no gap. A clinical intracardiac echocardiography system was programmed to transmit a custom diverging beam sequence at 600 Hz and used to image the ablation site before and after the induction of ablation lesions. Cumulative strains were estimated over systole using a normalized cross-correlational displacement algorithm and a least-squares strain kernel. Afterward, lesions were excised and subjected to tetrazolium chloride staining. Results indicate that intracardiac ME was capable of imaging the reduction in systolic strain associated with the formation of an ablation lesion. Furthermore, lesion sets containing gaps were able to be distinguished from lesion sets created with no gaps. These results indicate that the end-systolic strain measured using intracardiac ME may be used to image the formation of lesions induced during an RF ablation procedure, in order to provide critical assessment of lesion viability during the interventional procedure.
Collapse
|
4
|
Grondin J, Wan E, Gambhir A, Garan H, Konofagou E. Intracardiac myocardial elastography in canines and humans in vivo. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2015; 62:337-49. [PMID: 25643083 PMCID: PMC4315358 DOI: 10.1109/tuffc.2014.006784] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Intracardiac echocardiography (ICE) is a useful imaging modality which is used during RF ablation procedures to identify anatomical structures. Utilizing ICE in conjunction with myocardial elastography (ME) can provide additional information on the mechanical properties of cardiac tissue and provide information on mechanical changes caused by ablation. The objective of this study was to demonstrate that ICE can be used at high frame rate using a diverging beam transmit sequence to image myocardial strain and differentiate myocardial tissue properties before, during, and after ablation for a clinical ablation procedure. In this feasibility study, three normal canines and eight patients with atrial fibrillation (AF) were studied in vivo. A 5.8-MHz ICE transducer was used to image the heart with a diverging beam transmit method achieving 1200 frames per second (fps). Cumulative axial displacement estimation was performed using 1-D cross-correlation with a window size of 2.7 mm and 95% overlap. Axial cumulative strains were estimated in the left atrium (LA) and right atrium (RA) using a least-squares estimator with a kernel of 2 mm on the axial displacements. In the canine case, radial thickening was detected in the lateral wall and in the interatrial septum during LA emptying. For AF patients, the mean absolute strain in the ablated region was lower (6.7 ± 3.1%) than before the ablation (17.4 ± 9.3%) in LA at the end of the LA emptying phase. In the cavotricuspid isthmus (CTI) region, mean absolute strain magnitude at the end of the RA emptying phase was found to be higher during ablation (43.0 ± 18.1%) compared with after ablation (33.7 ± 15.8%). Myocardial strains in the LA of an AF patient were approximately 2.6 times lower in the ablated region than before ablation. This initial feasibility indicates that ME can be used as a new imaging modality in conjunction with ICE in RF ablation guidance and lesion monitoring.
Collapse
|
5
|
PANG GENNYA, BAY ERWIN, DEÁN-BEN XLUÍS, RAZANSKY DANIEL. Three-Dimensional Optoacoustic Monitoring of Lesion Formation in Real Time During Radiofrequency Catheter Ablation. J Cardiovasc Electrophysiol 2014; 26:339-45. [DOI: 10.1111/jce.12584] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/23/2014] [Accepted: 11/10/2014] [Indexed: 01/13/2023]
Affiliation(s)
- GENNY A. PANG
- Institute for Biological and Medical Imaging (IBMI); Helmholtz Center Munich; Neuherberg Germany
- Faculty of Medicine and Faculty of Electrical Engineering and Information Technology; Technical University of Munich; Munich Germany
| | - ERWIN BAY
- Institute for Biological and Medical Imaging (IBMI); Helmholtz Center Munich; Neuherberg Germany
- Faculty of Medicine and Faculty of Electrical Engineering and Information Technology; Technical University of Munich; Munich Germany
| | - X. LUÍS DEÁN-BEN
- Institute for Biological and Medical Imaging (IBMI); Helmholtz Center Munich; Neuherberg Germany
| | - DANIEL RAZANSKY
- Institute for Biological and Medical Imaging (IBMI); Helmholtz Center Munich; Neuherberg Germany
- Faculty of Medicine and Faculty of Electrical Engineering and Information Technology; Technical University of Munich; Munich Germany
| |
Collapse
|
6
|
Chang C, Moini A, Nikoozadeh A, Sarioglu AF, Apte N, Zhuang X, Khuri-Yakub BT. Singulation for imaging ring arrays of capacitive micromachined ultrasonic transducers. JOURNAL OF MICROMECHANICS AND MICROENGINEERING : STRUCTURES, DEVICES, AND SYSTEMS 2014; 24:107002. [PMID: 27076702 PMCID: PMC4827715 DOI: 10.1088/0960-1317/24/10/107002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Singulation of MEMS is a critical step in the transition from wafer-level to die-level devices. As is the case for capacitive micromachined ultrasound transducer (CMUT) ring arrays, an ideal singulation must protect the fragile membranes from the processing environment while maintaining a ring array geometry. The singulation process presented in this paper involves bonding a trench-patterned CMUT wafer onto a support wafer, deep reactive ion etching (DRIE) of the trenches, separating the CMUT wafer from the support wafer and de-tethering the CMUT device from the CMUT wafer. The CMUT arrays fabricated and singulated in this process were ring-shaped arrays, with inner and outer diameters of 5 mm and 10 mm, respectively. The fabricated CMUT ring arrays demonstrate the ability of this method to successfully and safely singulate the ring arrays and is applicable to any arbitrary 2D shaped MEMS device with uspended microstructures, taking advantage of the inherent planar attributes of DRIE.
Collapse
|
7
|
A Review of Catheter Related Complications During Minimally Invasive Transcatheter Cardiovascular Intervention with Implications for Catheter Design. Cardiovasc Eng Technol 2014. [DOI: 10.1007/s13239-014-0183-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
8
|
Stephens DN, Truong UT, Nikoozadeh A, Oralkan O, Seo CH, Cannata J, Dentinger A, Thomenius K, de la Rama A, Nguyen T, Lin F, Khuri-Yakub P, Mahajan A, Shivkumar K, O'Donnell M, Sahn DJ. First in vivo use of a capacitive micromachined ultrasound transducer array-based imaging and ablation catheter. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:247-56. [PMID: 22298868 PMCID: PMC3420825 DOI: 10.7863/jum.2012.31.2.247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. METHODS The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. RESULTS The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. CONCLUSIONS Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures.
Collapse
|
9
|
Seo CH, Stephens DN, Cannata J, Dentinger A, Lin F, Park S, Wildes D, Thomenius KE, Chen P, Nguyen T, de La Rama A, Jeong JS, Mahajan A, Shivkumar K, Nikoozadeh A, Oralkan O, Truong U, Sahn DJ, Khuri-Yakub PT, O'Donnell M. The feasibility of using thermal strain imaging to regulate energy delivery during intracardiac radio-frequency ablation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2011; 58:1406-17. [PMID: 21768025 PMCID: PMC3177537 DOI: 10.1109/tuffc.2011.1960] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A method is introduced to monitor cardiac ablative therapy by examining slope changes in the thermal strain curve caused by speed of sound variations with temperature. The sound speed of water-bearing tissue such as cardiac muscle increases with temperature. However, at temperatures above about 50°C, there is no further increase in the sound speed and the temperature coefficient may become slightly negative. For ablation therapy, an irreversible injury to tissue and a complete heart block occurs in the range of 48 to 50°C for a short period in accordance with the well-known Arrhenius equation. Using these two properties, we propose a potential tool to detect the moment when tissue damage occurs by using the reduced slope in the thermal strain curve as a function of heating time. We have illustrated the feasibility of this method initially using porcine myocardium in vitro. The method was further demonstrated in vivo, using a specially equipped ablation tip and an 11-MHz microlinear intracardiac echocardiography (ICE) array mounted on the tip of a catheter. The thermal strain curves showed a plateau, strongly suggesting that the temperature reached at least 50°C.
Collapse
Affiliation(s)
- Chi Hyung Seo
- University of California, Davis, Department of Biomedical Engineering, Davis, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Husseini GA, Stevenson-Abouelnasr D, Pitt WG, Assaleh KT, Farahat LO, Fahadi J. Kinetics and Thermodynamics of Acoustic Release of Doxorubicin from Non-stabilized polymeric Micelles. Colloids Surf A Physicochem Eng Asp 2010; 359:18-24. [PMID: 20495608 PMCID: PMC2872131 DOI: 10.1016/j.colsurfa.2010.01.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper studies the thermodynamic characteristics of ultrasound-activated release of Doxorubicin (Dox) from micelles. The release and re-encapsulation of Dox into Pluronic® P105 micelles was measured by recording the fluorescence of a solution of 10 µg/ml Dox and 10% wt P105 polymer in phosphate-buffered saline, during and after insonation by ultrasound at three temperatures, (25 °C, 37 °C and 56 °C). The experimental data were modeled using a previously-published model of the kinetics of the system. The model was simplified by the experimental measurement of one of the parameters, the maximum amount of Dox that can be loaded into the poly(propyleneoxide) cores of the micelles, which was found to be 89 mg/ml PPO and 150 mg Dox/ml PPO at 25 °C and 37 °C, respectively. From the kinetic constants and drug distribution parameters, we deduced the thermodynamic activation energy for micelle re-assembly and the residual activation energies for micelle destruction. Our model showed that the residual activation energy for destruction decreased with increasing acoustic intensity. In addition, higher temperatures were found to encourage micelle destruction and hinder micelle re-assembly.
Collapse
Affiliation(s)
- Ghaleb A. Husseini
- Chemical Engineering Department, American University of Sharjah, Sharjah, United Arab Emirates
| | | | - William G. Pitt
- Department of Chemical Engineering, Brigham Young University, Provo, Utah 84602
| | - Khaled T. Assaleh
- Electrical Engineering Department, American University of Sharjah, Sharjah, United Arab Emirates
| | - Lujein O. Farahat
- Chemical Engineering Department, American University of Sharjah, Sharjah, United Arab Emirates
| | - Jalal Fahadi
- Chemical Engineering Department, American University of Sharjah, Sharjah, United Arab Emirates
| |
Collapse
|