1. Place animal in induction chamber and anesthetize the mouse and ensure sedation. 2. Once the animal is sedated, move it to a nose cone for hair removal using cream. Only apply cream to the area of the chest that will be utilized for imaging. Once the hair is removed, wipe area with wet gauze to ensure all hair is removed. 3. Move the animal to the imaging platform and tape its paws to the ECG lead plates and insert rectal probe. Body temperature should be maintained at 36-37°C. During imaging, reduce anesthesia to maintain proper heart rate. If the animal shows signs of being awake, use a higher concentration of anesthetic.

人唾液天疱疮抗原的纯化

Worldwide, there have been more than 6500 MitraClip procedures performed to treat either functional or degenerative mitral regurgitation (MR). The MitraClip procedure is the only available percutaneous device available to reduce MR by creating a double mitral valve (MV) orifice and decreasing MV annular diameter. As the mitral leaflets cannot be assessed by fluoroscopy, procedural success is dependent upon echocardiographic guidance. In this review, we describe the assessment necessary to determine eligibility for the MitraClip procedure. This includes accurate assessment of MR and detailed analysis of MV morphology by 2D and 3D echocardiography. In addition, each of the intraprocedural steps involved in the deployment of this device and the guidance of these steps by 2D and 3D echo are described in detail, along with the use of echo to detect procedural complications. Thus the focus of this review is on the peri-interventional echocardiographic assessment before, during, and after the MitraClip procedure.

Peri-interventional echo assessment for the MitraClip procedure

Background— The aim of this study was to test the accuracy of an automated 3-dimensional (3D) proximal isovelocity surface area (PISA) (in vitro and patients) and stroke volume technique (patients) to assess mitral regurgitation (MR) severity using real-time volume color flow Doppler transthoracic echocardiography.

Methods and Results— Using an in vitro model of MR, the effective regurgitant orifice area and regurgitant volume (RVol) were measured by the PISA technique using 2-dimensional (2D) and 3D (automated true 3D PISA) transthoracic echocardiography. The mean anatomic regurgitant orifice area (0.35±0.10 cm2) was underestimated to a greater degree by the 2D (0.12±0.05 cm2) than the 3D method (0.25±0.10 cm2; P 0.05 for both). In patients (n=30, functional MR), 3D effective regurgitant orifice area correlated well with cardiac magnetic resonance imaging RVol r =0.84 and regurgitant fraction r =0.80. Compared with cardiac magnetic resonance imaging RVol (33±22 mL), the integrated PISA RVol (34±26 mL; P =0.42) was not significantly different; however, the peak PISA RVol was higher (48±27 mL; P <0.001). In addition, RVol calculated as the difference in automated mitral and aortic stroke volumes by real-time 3D volume color flow Doppler echocardiography was not significantly different from cardiac magnetic resonance imaging (34±21 versus 33±22 mL; P =0.33).

Conclusions— Automated real-time 3D volume color flow Doppler based 3D PISA is more accurate than the 2D PISA method to quantify MR. In patients with functional MR, the 3D RVol by integrated PISA is more accurate than a peak PISA technique. Automated 3D stroke volume measurement can also be used as an adjunctive method to quantify MR severity.

Quantification of chronic functional mitral regurgitation by automated 3-dimensional peak and integrated proximal isovelocity surface area and stroke volume techniques using real-time 3-dimensional volume color Doppler echocardiography: in vitro and clinical validation.

Registration of 3D trans-esophageal echocardiography to X-ray fluoroscopy using image-based probe tracking

Background The two-dimensional (2D) proximal isovelocity surface area (PISA) method has some technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat, real-time three-dimensional (3D) color Doppler imaging allows direct measurement of PISA without geometric assumptions. The aim of this study was to validate this novel method in patients with chronic mitral regurgitation (MR). Methods Thirty-three patients were included, 25 (75.7%) with degenerative MR and eight (24.2%) with functional MR. EROA and regurgitant volume were assessed using transthoracic 2D and 3D PISA methods. The quantitative Doppler method and 3D transesophageal echocardiographic planimetry of EROA were used as reference methods. Results Both EROA and regurgitant volume assessed using the 3D PISA method had better correlations with the reference methods than conventional 2D PISA. A consistent significant underestimation of EROA and regurgitant volume using 2D PISA was observed, particularly in the assessment of eccentric jets. On the basis of 3D transesophageal echocardiographic planimetry of EROA, 14 patients had severe MR (EROA ≥ 0.4 cm 2 ). Of these 14 patients, 42.8% (6 of 14) were underestimated as having nonsevere MR (EROA ≤ 0.4 cm 2 ) by the 2D PISA method. In contrast, the 3D PISA method had 92.9% (13 of 14) agreement with 3D transesophageal planimetry in classifying severe MR. Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.96 and 0.92, respectively. Conclusions Direct measurement of PISA without geometric assumptions using single-beat, real-time 3D color Doppler echocardiography is feasible in the clinical setting. MR quantification using this methodology is more accurate than the conventional 2D PISA method.

Direct measurement of proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography in mitral regurgitation: a validation study.

We present the first system for measurement of proximal isovelocity surface area (PISA) on a 3D ultrasound acquisition using modified ultrasound hardware, volumetric image segmentation and a simple efficient workflow. Accurate measurement of the PISA in 3D flow through a valve is an emerging method for quantitatively assessing cardiac valve regurgitation and function. Current state of the art protocols for assessing regurgitant flow require laborious and time consuming user interaction with the data, where a precise execution is crucial for an accurate diagnosis. We propose a new improved 3D PISA workflow that is initialized interactively with two points, followed by fully automatic segmentation of the valve annulus and isovelocity surface area computation. Our system is first validated against several in vitro phantoms to verify the calculations of surface area, orifice area and regurgitant flow. Finally, we use our system to compare orifice area calculations obtained from in vivo patient imaging measurements to an independent measurement and then use our system to successfully classify patients into mild-moderate regurgitation and moderate-severe regurgitation categories.

/pdf/regurgitation-quantification-using-3d-pisa-in-volume-3tgjvsvlg0.pdf

Regurgitation quantification using 3D PISA in volume echocardiography

Therapy control and/or monitoring is performed with an ultrasound scanner. The ultrasound scanner detects temperature to monitor therapy, and perform HIFU beam location refocusing of the therapy system based on the temperature. The monitoring is synchronized with the therapy using a trigger output of the ultrasound scanner. The trigger output responds to a scan sequence of the ultrasound scanner. To meet a given therapy plan, the scan sequence is customized, resulting in the customized trigger sequence. Three dimensional or multi-planar reconstruction rendering is used to represent temperature for monitoring feedback. The temperature at locations not being treated may be monitored. If the temperature has an undesired characteristic (e.g., too high), then the therapy is controlled by ceasing, at least temporarily.

Ultrasound for Therapy Control or Monitoring

This paper describes a novel method for improving the navigation and guidance of devices and catheters in electrophysiology and interventional cardiology procedures using volumetric data fusion. The clinical workflow includes the acquisition and reconstruction of CT data from a C-arm X-ray angiographic system and the real-time acquisition of volumetric ultrasound datasets with a new intracardiac real-time 3D ultrasound catheter. Mono- and multi-modal volumetric registration methods, as well as visualization modes, that are suitable for real-time fusion are described, which are the key components of this work. Evaluation on phantom and in-vivo animal data shows that it is feasible to register and track the motion of real-time 3D intracardiac ultrasound in C-arm CT.

/pdf/towards-guidance-of-electrophysiological-procedures-with-4ap6a8v8ov.pdf

Towards Guidance of Electrophysiological Procedures with Real-Time 3D Intracardiac Echocardiography Fusion to C-arm CT

Volumetric quantification is provided in medical diagnostic ultrasound. By acquiring both B-mode and color flow data without stitching or acquiring in real-time at tens of volumes a second, more reliable quantification may be provided. Using multiple regions of interest in a volume may allow for more accurate and/or complete flow information, such as averaging flow from different locations in the same structure (e.g., use preservation of mass to acquire multiple measures of the same flow).

Volumetric Quantification for Ultrasound Diagnostic Imaging

A method for registration of ultrasound device in three dimensions to a C-arm scan, the method including acquiring a baseline volume, acquiring images in which the ultrasound device is disposed, locating the device within the images, registering the location of the device to the baseline volume, acquiring an ultrasound volume from the ultrasound device, registering the ultrasound volume to the baseline volume, and performing fusion imaging to display a view of the ultrasound device in the baseline volume.

Fusion of 3D volumes with CT reconstruction

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