腔内超声应用进展

腔内超声应用进展-议程心内超声技术简介心内超声的临床应用文献回顾议程心内超声技术简介心内超声的临床应用文献回顾

Ultrasoundissoundwithfrequencygreaterthan20,000cyclespersecondor20kHz.Audiblesoundsensedbythehumanearareintherangeof20Hzto20kHz

Ultrasoundisanimagingtechniquethatuseshighfrequencysoundwavesandtheirechoes心内超声简介Thistechniqueissimilartotheecho-locationusedbybats,whalesanddolphinsaswellasSONARusedbysubmarines心内超声简介

Theultrasoundwavesareemittedbythetransducer,transmittedthroughthetissueandarereflected,refractedorabsorbedbythetissue

心内超声简介IntracardiacEchocardiography

Whenthemarkersonthe

handlearelinedup,theUSbeamiscomingoffthesideofthetipofthecatheterinthatplane心内超声简介SOUNDSTAR超声探头相控阵探头（64）模式2D/Color/M-mode/PW/CW/TissueDoppler频率4-10MHz（依超声机不同）系统兼容西门子：SC2000GE:VIVIDi,VIVIDq尺寸10F/90cm打弯四向(A/P/L/R)，130度打弯三维功能与CARTO3系统兼容超声探头sensor心内超声简介—Soundstar超声导管心内超声简介—二维超声图像心内超声简介—超声多普勒SpectralDoppler

BloodmovingtowardsthetransducerwillbedisplayedabovethebaselineBloodmovingawayfromthetransducerwillbedisplayedbelowthebaseline.BloodflowawayfromthetransducerBloodflowtowardthetransducerColorflowDopplerusespulsedwavesandproducesacolor-codedmapsuperimposedontothe2-DimageUsedtoassessbloodflowwithinheartandbloodvesselsColorflowDopplercalculatesmeanbloodvelocity,directionandflowatmultiplepointsLeftPulmonaryVenousInflow心内超声简介—彩色血流多普勒Increasing

flowvelocity

towardthe

transducerIncreasing

flowvelocity

awayfrom

thetransducerZeroflowBART BlueAway-fromthetransducer

RedToward-thetransducer心内超声简介—彩色血流多普勒议程心内超声技术简介心内超声的临床应用文献回顾实时影像识别解剖结构房间隔穿刺显示导管接触监测并发症三维标测从右房建立左房及其他心腔模型与CT精确融合-SoundMerge实时构建心腔-HDSoundMap提高标测效率三维下显示超声导管位置和超声扇面

提高手术成功率提高手术效率与安全性缩短电生理医生学习曲线心内超声的临床应用TransseptalpunctureMonitorforadverseeventsA-FibablationproceduresVTablation–aorticcusp&RVOTablationAtrialflutterablationComplexcardiacanatomyfromcongenitalheartdefectsBi-Ventricularpacingforcardiacresynchronization起搏与心电生理心内超声导管的临床应用—二维超声功能DeviceplacementforseptalabnormalitiesLeftatrialappendagedeviceplacementValvuloplastyAtrialseptostomyAnytransseptalorleft-sidedcaseComplexcardiacanatomyfromcongenitalheartdefectsThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveowners介入心内科心内超声导管的临床应用—二维超声功能所有的二维超声导管功能MappingforA-FibablationproceduresVTablation–mappingforaorticcusp&RVOTablationComplexablationsinvolvingnumerousabnormalconductionpathwaysLVablations心内超声导管的临床应用—三维超声功能房颤手术SoundMerge标测HDSoundMapping房间隔穿刺LAA血栓检查室性手术三尖瓣环肺动脉瓣主动脉窦乳头肌疤痕并发症监测穿刺并发症心包积液导管头端血栓FAM+Sound标测（2.0s）心内超声导管的临床应用降低房颤学习难度、提高手术效率（房颤2.0s）穿间隔标测建壳定口高精密度标测消融房颤关键技术X线经验手感STCARTOSOUND让房颤消融更简单、有效和安全！LassoNav房颤消融2.0sSoundstar构建左房Soundstar下指导房间隔穿刺LassoNav构建肺静脉（必要时左房基质或CFAE标测）Soundstar监测下ST环肺静脉隔离HDPM处理房颤术后房速与房扑缩短电生理手术学习曲线提高房颤和室性成功率保证手术安全性降低X线曝光和造影剂用量精确、简单、安全心内超声的临床应用议程心内超声技术简介心内超声的临床应用文献回顾心内超声的应用JAmCollCardiol2009;53:2117–28心内超声的应用JAmCollCardiol2009;53:2117–28心内超声的应用JAmCollCardiol2009;53:2117–28心内超声的应用JAmCollCardiol2009;53:2117–28心内超声的应用JAmCollCardiol2009;53:2117–28心内超声的应用JAmCollCardiol2009;53:2117–28最早的心内超声应用经验JAmColl

Cardiol2002;39:509–16最早的腔内超声应用经验JAmColl

Cardiol2002;39:509–16最早的心内超声应用经验JAmColl

Cardiol2002;39:509–16最早的心内超声应用经验JAmColl

Cardiol2002;39:509–16最早的心内超声应用经验JAmColl

Cardiol2002;39:509–16HeartRhythm2008;5:1403–1410心内超声在房颤中的应用HeartRhythm2008;5:1403–1410腔内超声在房颤中的应用HeartRhythm2008;5:1403–1410心内超声在房颤中的应用HeartRhythm2011;8:1669–1675心内超声在房颤中的应用-特殊房间隔穿刺HeartRhythm2011;8:1669–1675心内超声在房颤中的应用-特殊房间隔穿刺HeartRhythm2011;8:1669–1675心内超声在房颤中的应用-特殊房间隔穿刺HeartRhythm2006;3:1156–1161心内超声在房颤中的应用-食道位置监测HeartRhythm2006;3:1156–1161心内超声在房颤中的应用-食道位置监测42CompanyConfidentialFigure2.Intracardiacechocardiographyimageswithtransducerplacedintherightatrium(RA)demonstrateasingle,linear,andmobilethrombus(arrows)attachedatthesheathofLasso(leftupperpanel),pullingthesheath/Lassowiththrombusback(rightupperpanel)andwithdrawalofthrombusfromtheleftatrium(LA)(leftlowerpanel)intotheRA(rightlowerpanel).Aoaorta;LVleftventricle.心内超声在房颤中的应用-减少并发症Europace(2013)15,24–3243CompanyConfidential心内超声在房颤中的应用-减少并发症Europace(2013)15,24–32Proceduresafetyisenhancedbyusing3DICE44CompanyConfidentialTypeofComplicationRateNo.ofPatients%Death520.15Tamponade2131.31Pneumothorax150.09Hemothorax40.02Sepsis,abscesses,orendocarditis20.01Permanentdiaphragmaticparalysis280.17Totalfemoralpseudoaneurysm1520.93Totalartero-venousfistulae880.54Valvedamage/requiringsurgery11/70.07Atrium-esophagealfistulae60.04Stroke370.23Transientischemicattack1150.71PVstenosisrequiringintervention480.29Total7414.54Cappatoetal.“UpdatedWorldwideSurveyontheMethods,Efficacy,andSafetyofCatheterAblationforHumanAtrialFibrillation”Circulation2010;3:32-38..TheSoundStar®Catheterallowsthephysiciantomonitorforeventsinreal-time,toreduceriskofcomplicationsMonitorforpericardialeffusionMonitorforthrombusformationCatheterpositioninganddopplerflow/velocitymonitoringtodetectPVstenosisMonitorlocationofesophagusandablationcatheter心内超声在房颤中的应用-减少并发症45CompanyConfidentialConclusion:ThesuggestedmanagementstrategyisthatcontinuousICEimagingmonitoringmaypreventordecreaseLAthrombuscomplications.Figure2.Intracardiacechocardiographyimageswithtransducerplacedintherightatrium(RA)demonstrateasingle,linear,andmobilethrombus(arrows)attachedatthesheathofLasso(leftupperpanel),pullingthesheath/Lassowiththrombusback(rightupperpanel)andwithdrawalofthrombusfromtheleftatrium(LA)(leftlowerpanel)intotheRA(rightlowerpanel).Aoaorta;LVleftventricle.心内超声在房颤中的应用-减少并发症JACC.May19,2004;43(10):1861-7Conclusion:3DICEreconstructionofLAandPVostialanatomycorrelatedwellwiththatofCTimaging,andmayprovidesuperiorinformationregardingesophageallocation.Thelearningcurveisrapid,andaccuratereconstructionofLAvolumecanbeobtained.ICECTPLAVolume108+/-41ml118+36mlr=0.74p<0.00013DICEAccuratelyReflectedAnatomyIdentifiedByCT46CompanyConfidential心内超声在房颤中的应用-减少并发症VasaiwalaSC,BrysiewiczN,AkarJG.HeartRhythmSociety2008;AB30-3.心内超声在房颤中的应用-血栓监测JAmCollCardiol2004;43:1861–7心内超声在房颤中的应用-血栓监测JAmCollCardiol2004;43:1861–7心内超声在房颤中的应用-血栓监测71例患者全部通过ICE完成了RAA及LAA成像，而由于2例患者超声探头不能通过食道，只有69例患者完成TEE心耳评估。HeartRhythm2014;11:1890–1897图像质量更高心内超声在房颤中的应用-血栓监测ICE与TEE的LAA诊断成像率比较结果为100%vs.87.3%，P＜0.002。最终共发现了4例血栓（3例在LAA，1例在RAA）。但TEE只发现了其中1例，而ICE发现全部4例。心内超声在房颤中的应用-血栓监测心内超声在特发性室速中的应用EurJEchocardiography(2004)5,34e40心内超声在特发性室速中的应用EurJEchocardiography(2004)5,34e40心内超声在特发性室速中的应用EurJEchocardiography(2004)5,34e40心内超声在特发性室速中的应用HeartRhythm2010;7:312–322心内超声在特发性室速中的应用HeartRhythm2010;7:312–322心内超声在器质性室速中的应用HeartRhythm2008;5:1396–1402心内超声在器质性室速中的应用HeartRhythm2008;5:1396–1402心内超声在器质性室速中的应用HeartRhythm2008;5:1396–1402心内超声在器质性室速中的应用(JCardiovasc

Electrophysiol,Vol.21,pp.678-684,June2010)(JCardiovasc

Electrophysiol,Vol.21,pp.678-684,June2010)Soundstar在器质性室速中的应用(JCardiovasc

Electrophysiol,Vol.21,pp.678-684,June2010)心内超声在器质性室速中的应用Conclusion:ICEprovidesanatomicaldetailof