CartoSound-在房性心律失常中的應(yīng)用課件

CartoSound在房性心律失常中的應(yīng)用CartoSound在房性心律失常中的應(yīng)用1工欲善其事必先利其器工欲善其事必先利其器2CartoSound在房性心律失常中的應(yīng)用對心房結(jié)構(gòu)的認識ICE指導(dǎo)下的房間隔穿刺CartoSound下的左房建模與消融食道位置的識別并發(fā)癥的監(jiān)測CartoSound在右房中的應(yīng)用CartoSound在房性心律失常中的應(yīng)用對心房結(jié)構(gòu)的認識3FossaOvalis

FossaOvalisView–FromtheLAAview,smallmovements(clockwiseorcounterclockwise)willoptimizethefossaovalisview.Youmayhavetoadvancethecatheterslightlyinordertocentertheview.Inpreparationforguidanceofthetransseptalpuncture(TSP)fromthisview,itmaybenecessarytoengagethetensionorlockfunctiononthecatheter.Also,usesomeposteriortiltandpossiblyrightsteeringtooptimizethefossa.

FossaOvalis FossaOvalisVie4

LeftAtrialAppendageView–Theleftatrialappendage(LAA)isseeninasimilarplanetothatoftheLeftPulmonaryVeins.TheLAAisvisualizedusingfurtherclockwiserotation.TheIAS,MVandLAAwillusuallycomeintoview.TheLAAisoftenvisualizedinthesameplaneasthemitralvalveandwillappearasan“out-pouching”fromtheLA.LeftAtrialAppendage

LeftAtrialAppendageView–5LeftPulmonaryVeins–Fromthefossaview,youmayneedtodisengagesteeringandrotateslightlyclockwise.Theleftinferiorpulmonaryvein(LIPV)andleftsuperiorpulmonaryvein(LSPV)areusuallyseeninthesameplane.UtilizecolorDopplertoassistwithidentifyingthepulmonaryveins.

LeftPulmonaryVeins

LeftPulmonaryVeins–Fromth6RightPulmonaryVeins–Fromtheleftveinscontinueclockwiserotation.Therightinferiorpulmonaryvein(RIPV)andtherightsuperiorpulmonaryvein(RSPV)willappearclosetotheimagingsurfaceoftheACUNAV?image.Inordertoviewtherightsuperiorpulmonaryvein(RSPV)morelongitudinally,advancethecatheterandcontinueclockwiserotation.Inmanycasestheadditionofanteriortiltandright/leftsteeringatthistimewillfurtheroptimizetheimage.

RightPulmonaryVeins

ansverseSinusTRANSVERSESINUSThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersRightPulmonaryVeins–Fromt7CavoTricuspidIsthmus

CavoTricuspid

IsthmusView–TheisthmusviewcanbeobtainedbyrotatingtheACUNAV?catheterclockwisefromthecristaviewbacktothe“HomePosition”view.Oncethisviewisobtained,withdrawtheACUNAV?catheteroutofthepatientslightly.Thiswillallowanimageoftheeustachianridgetobevisualized.Theisthmusistheareabetweentheeustachianridgeandthetricuspidvalve.

Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersCavoTricuspidIsthmus CavoT8

CristaTerminalisView–fromthe“HomePosition,”rotatetheACUNAV?cathetercounterclockwise,ortowardsthepatient’sright.Thecristaisananteriorstructure,sotheimagingfaceoftheACUNAV?catheterisbeingrotatedtolookanteriorly.ThecristaisalsoamoresuperficialstructureinrelationtotheACUNAV?

imagingsurface,sothe“depth”knobmayneedtobeadjustedtoshowonlyanatomicalstructuresthatareclosertothecatheter.Acommondepthtofocusthecristais30-50cm.

CristaTerminalisThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveowners CristaTerminalisView–from9AtrialSeptalAbnormalitiesPatentForamenOvale(PFO)Smallflap-likeopeningintheinter-atrialseptumfromfetalcirculation1in4peoplehaveaPFOthatpersiststhroughoutlifeMostpeoplehavenosymptomsPFOisassociatedwithstrokeAdefect(hole)betweenthetwoatriaSurgicalvs.percutaneousrepairAtrialSeptalDefect(ASD)AtrialSeptalAbnormalitiesPat10SeptalTunnel(PFO)SeptalTunnel(PFO)11SeptalTunnel(PFO)SeptalTunnel(PFO)12AtrialSeptalDefectFenestratedAtrialSeptalDefectFenestrate13AneurysmalAtrialSeptumAneurysmalAtrialSeptum14ICE指導(dǎo)下的房間隔穿刺——更安全卵圓孔和穿刺針可視構(gòu)建出相鄰解剖結(jié)構(gòu)減少x線使用鹽水替代造影劑驗證在三維殼上標記卵圓窩提高安全性和優(yōu)化位置應(yīng)對復(fù)雜穿刺情況保護患者和醫(yī)生減少腎臟負荷方便導(dǎo)管回到左房三維超聲下房間隔穿刺ICE指導(dǎo)下的房間隔穿刺——更安全卵圓孔和穿刺針可視提高安全15TentingwascalledbyTEE–DoyouseetentingwithACUNAV????UsingACUNAV?toGuideTransseptalPunctureThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersTentingwascalledbyTEE–Do16TransseptalPunctureTransseptalPuncture17UsingACUNAV?toGuideTransseptalPunctureWheredidtheneedleendup?Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersUsingACUNAV?toGuideTransse18使用肝素鹽水替代造影劑驗證TransseptalPuncture使用肝素鹽水替代造影劑驗證TransseptalPunct19SOUNDSTAR構(gòu)建左房三維模型SOUNDSTAR構(gòu)建左房三維模型20SOUNDSTAR構(gòu)建左房三維模型SOUNDSTAR構(gòu)建左房三維模型21CartoSound左房建模——SoundMap法CartoSound左房建?！猄oundMap法22CartoSound左房建?！猄oundMap+AF2.0CartoSound左房建模——SoundMap+AF2.023CartoSound左房建?！猄oundMap

+CTmergeCartoSound左房建模—SoundMap

24AblationCatheterVisualizationandLocationImprovesphysicianconfidencewithreal-timevisualizationoftheexactlocationoftheablationcatheterClinicalBenefits–CARTOSOUND?AblationCatheterVisualizatio25CASE

CartoSound指導(dǎo)下的房顫消融（我院經(jīng)驗）患者，男性，61歲病史：ParoxysmalAF5y既往史：高血壓UCG：LA42mmLV48mmRA34mmLVEF0.6術(shù)前診斷：1.心律失常陣發(fā)性房顫2.高血壓病3級（極高危）CASE

CartoSound指導(dǎo)下的房顫消融（我院經(jīng)驗）26CreatingSoundMapCreatingSoundMap27TransseptalPuncture監(jiān)視穿刺針的位置選擇出針方向和力度觀察房間隔形態(tài)變化視覺結(jié)合手感判斷是否穿過使用鹽水替代造影劑TransseptalPuncture監(jiān)視穿刺針的位置28FAMvs.SoundMap大頭詳細FAM肺靜脈可以代替定口超聲指導(dǎo)：更真實的特殊結(jié)構(gòu)FAMvs.SoundMap29DuringAblation-消融DuringAblation-消融30DuringAblation–消融點分布LPV偏心耳側(cè)消融模型輪廓和消融點有距離RPV后壁完美直觀的勾勒肺靜脈開口，指導(dǎo)消融DuringAblation–消融點分布LPV31DuringAblation-大頭監(jiān)視DuringAblation-大頭監(jiān)視32DuringAblation超聲與三維影像實時對應(yīng)消融點與大頭在超聲圖上顯影DuringAblation超聲與三維影像實時對應(yīng)33EsophagusEsophagus34EsophagealLocalizationEsophagealLocalization35EsophagealLocalizationEsophagealLocalization36診斷LAA血栓SOUNDSTAR導(dǎo)管：耐受性好RAA（位于右房）和LAA圖像質(zhì)量高（位于肺動脈）TEE診斷心耳血栓，當(dāng)：患者不能耐受圖像質(zhì)量差時，SOUNDSTAR是TEE的可靠替代手段診斷LAA血栓SOUNDSTAR導(dǎo)管：37CartoSound檢查LAA血栓房間隔左房左心耳CartoSound檢查LAA血栓房間隔左房左心耳38CallansDJ,MarchlinskiFE,RenJF.LeftAtrialThrombusAssociatedWithAblationForAtrialFibrillation:IdentificationWithIntracardiacEchocardiography.JACC.May19,2004;43(10):1861-7MonitorforThrombusThrombusisidentifiedin10.3%ofleft-sidedcasesCallansDJ,MarchlinskiFE,Re39MonitorforThrombusMonitorforThrombus40PericardialEffusionTamponadePericardialEffusionTamponade41CARTOSOUND在右房房撲

和房速手術(shù)中的應(yīng)用CARTOSOUND在右房房撲

和房速手術(shù)中的應(yīng)用42AtrialFlutterAblationTricuspidIsthmusCristaTerminalisAtrialFlutterAblationTricusp43RightAtrialMappingRightAtrialMapping44RightAtrialMappingRightAtrialMapping45RightAtrialMappingRightAtrialMapping46RightAtrialFlutterRightAtrialFlutter47房撲：CTI解剖和Pouch位置Pouch位置在Pouch部位的消融PouchCTI導(dǎo)管位于Pouch房撲：CTI解剖和Pouch位置Pouch位置在Pouch部48房撲：判斷導(dǎo)管在CTI在歐式嵴的貼靠情況導(dǎo)管未貼靠導(dǎo)管貼靠歐式嵴消融導(dǎo)管消融導(dǎo)管貼靠在CTI房撲：判斷導(dǎo)管在CTI在歐式嵴的貼靠情況導(dǎo)管未貼靠導(dǎo)管貼靠歐49CARTOSOUND下的CTI消融方法CARTOSOUND下的CTI消融方法50復(fù)雜房速：發(fā)現(xiàn)未知

復(fù)雜病例精確、自信辨別解剖結(jié)構(gòu)適用于全心腔的標測策略復(fù)雜房速：發(fā)現(xiàn)未知

復(fù)雜病例精確、自信適用于全心腔的51總結(jié)縮短電生理手術(shù)學(xué)習(xí)曲線提高手術(shù)成功率保證手術(shù)安全性降低X線曝光和造影劑用量精確、簡單、安全CARTOSOUND+SOUNDSTAR總結(jié)縮短電生理手術(shù)學(xué)習(xí)曲線提高手術(shù)成功率保證手術(shù)安全性降52謝謝CartoSound-在房性心律失常中的應(yīng)用課件53CartoSound在房性心律失常中的應(yīng)用CartoSound在房性心律失常中的應(yīng)用54工欲善其事必先利其器工欲善其事必先利其器55CartoSound在房性心律失常中的應(yīng)用對心房結(jié)構(gòu)的認識ICE指導(dǎo)下的房間隔穿刺CartoSound下的左房建模與消融食道位置的識別并發(fā)癥的監(jiān)測CartoSound在右房中的應(yīng)用CartoSound在房性心律失常中的應(yīng)用對心房結(jié)構(gòu)的認識56FossaOvalis

FossaOvalisView–FromtheLAAview,smallmovements(clockwiseorcounterclockwise)willoptimizethefossaovalisview.Youmayhavetoadvancethecatheterslightlyinordertocentertheview.Inpreparationforguidanceofthetransseptalpuncture(TSP)fromthisview,itmaybenecessarytoengagethetensionorlockfunctiononthecatheter.Also,usesomeposteriortiltandpossiblyrightsteeringtooptimizethefossa.

FossaOvalis FossaOvalisVie57

LeftAtrialAppendageView–Theleftatrialappendage(LAA)isseeninasimilarplanetothatoftheLeftPulmonaryVeins.TheLAAisvisualizedusingfurtherclockwiserotation.TheIAS,MVandLAAwillusuallycomeintoview.TheLAAisoftenvisualizedinthesameplaneasthemitralvalveandwillappearasan“out-pouching”fromtheLA.LeftAtrialAppendage

LeftAtrialAppendageView–58LeftPulmonaryVeins–Fromthefossaview,youmayneedtodisengagesteeringandrotateslightlyclockwise.Theleftinferiorpulmonaryvein(LIPV)andleftsuperiorpulmonaryvein(LSPV)areusuallyseeninthesameplane.UtilizecolorDopplertoassistwithidentifyingthepulmonaryveins.

LeftPulmonaryVeins

LeftPulmonaryVeins–Fromth59RightPulmonaryVeins–Fromtheleftveinscontinueclockwiserotation.Therightinferiorpulmonaryvein(RIPV)andtherightsuperiorpulmonaryvein(RSPV)willappearclosetotheimagingsurfaceoftheACUNAV?image.Inordertoviewtherightsuperiorpulmonaryvein(RSPV)morelongitudinally,advancethecatheterandcontinueclockwiserotation.Inmanycasestheadditionofanteriortiltandright/leftsteeringatthistimewillfurtheroptimizetheimage.

RightPulmonaryVeins

ansverseSinusTRANSVERSESINUSThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersRightPulmonaryVeins–Fromt60CavoTricuspidIsthmus

CavoTricuspid

IsthmusView–TheisthmusviewcanbeobtainedbyrotatingtheACUNAV?catheterclockwisefromthecristaviewbacktothe“HomePosition”view.Oncethisviewisobtained,withdrawtheACUNAV?catheteroutofthepatientslightly.Thiswillallowanimageoftheeustachianridgetobevisualized.Theisthmusistheareabetweentheeustachianridgeandthetricuspidvalve.

Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersCavoTricuspidIsthmus CavoT61

CristaTerminalisView–fromthe“HomePosition,”rotatetheACUNAV?cathetercounterclockwise,ortowardsthepatient’sright.Thecristaisananteriorstructure,sotheimagingfaceoftheACUNAV?catheterisbeingrotatedtolookanteriorly.ThecristaisalsoamoresuperficialstructureinrelationtotheACUNAV?

imagingsurface,sothe“depth”knobmayneedtobeadjustedtoshowonlyanatomicalstructuresthatareclosertothecatheter.Acommondepthtofocusthecristais30-50cm.

CristaTerminalisThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveowners CristaTerminalisView–from62AtrialSeptalAbnormalitiesPatentForamenOvale(PFO)Smallflap-likeopeningintheinter-atrialseptumfromfetalcirculation1in4peoplehaveaPFOthatpersiststhroughoutlifeMostpeoplehavenosymptomsPFOisassociatedwithstrokeAdefect(hole)betweenthetwoatriaSurgicalvs.percutaneousrepairAtrialSeptalDefect(ASD)AtrialSeptalAbnormalitiesPat63SeptalTunnel(PFO)SeptalTunnel(PFO)64SeptalTunnel(PFO)SeptalTunnel(PFO)65AtrialSeptalDefectFenestratedAtrialSeptalDefectFenestrate66AneurysmalAtrialSeptumAneurysmalAtrialSeptum67ICE指導(dǎo)下的房間隔穿刺——更安全卵圓孔和穿刺針可視構(gòu)建出相鄰解剖結(jié)構(gòu)減少x線使用鹽水替代造影劑驗證在三維殼上標記卵圓窩提高安全性和優(yōu)化位置應(yīng)對復(fù)雜穿刺情況保護患者和醫(yī)生減少腎臟負荷方便導(dǎo)管回到左房三維超聲下房間隔穿刺ICE指導(dǎo)下的房間隔穿刺——更安全卵圓孔和穿刺針可視提高安全68TentingwascalledbyTEE–DoyouseetentingwithACUNAV????UsingACUNAV?toGuideTransseptalPunctureThethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersTentingwascalledbyTEE–Do69TransseptalPunctureTransseptalPuncture70UsingACUNAV?toGuideTransseptalPunctureWheredidtheneedleendup?Thethirdpartytrademarksusedhereinaretrademarksof

theirrespectiveownersUsingACUNAV?toGuideTransse71使用肝素鹽水替代造影劑驗證TransseptalPuncture使用肝素鹽水替代造影劑驗證TransseptalPunct72SOUNDSTAR構(gòu)建左房三維模型SOUNDSTAR構(gòu)建左房三維模型73SOUNDSTAR構(gòu)建左房三維模型SOUNDSTAR構(gòu)建左房三維模型74CartoSound左房建模——SoundMap法CartoSound左房建?！猄oundMap法75CartoSound左房建?！猄oundMap+AF2.0CartoSound左房建?！猄oundMap+AF2.076CartoSound左房建模—SoundMap

+CTmergeCartoSound左房建?！猄oundMap

77AblationCatheterVisualizationandLocationImprovesphysicianconfidencewithreal-timevisualizationoftheexactlocationoftheablationcatheterClinicalBenefits–CARTOSOUND?AblationCatheterVisualizatio78CASE

CartoSound指導(dǎo)下的房顫消融（我院經(jīng)驗）患者，男性，61歲病史：ParoxysmalAF5y既往史：高血壓UCG：LA42mmLV48mmRA34mmLVEF0.6術(shù)前診斷：1.心律失常陣發(fā)性房顫2.高血壓病3級（極高危）CASE

CartoSound指導(dǎo)下的房顫消融（我院經(jīng)驗）79CreatingSoundMapCreatingSoundMap80TransseptalPuncture監(jiān)視穿刺針的位置選擇出針方向和力度觀察房間隔形態(tài)變化視覺結(jié)合手感判斷是否穿過使用鹽水替代造影劑TransseptalPuncture監(jiān)視穿刺針的位置81FAMvs.SoundMap大頭詳細FAM肺靜脈可以代替定口超聲指導(dǎo)：更真實的特殊結(jié)構(gòu)FAMvs.SoundMap82DuringAblation-消融DuringAblation-消融83DuringAblation–消融點分布LPV偏心耳側(cè)消融模型輪廓和消融點有距離RPV后壁完美直觀的勾勒肺靜脈開口，指導(dǎo)消融DuringAblation–消融點分布LPV84DuringAblation-大頭監(jiān)視DuringAblation-大頭監(jiān)視85DuringAblation超聲與三維影像實時對應(yīng)消融點與大頭在超聲圖上顯影DuringAblation超聲與三維影像實時對應(yīng)86EsophagusEsophagus8