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CLINICAL STUDY: NEW METHODS

Intracardiac phased-array imaging: methods and initial clinical experience with high resolution, under blood visualization

Initial experience with intracardiac phased-array ultrasound

^* Division of Cardiology, Mayo Foundation, Rochester, Minnesota, USA

Manuscript received August 3, 2000; revised manuscript received October 10, 2001, accepted October 31, 2001.

^* Reprint requests and correspondence: Dr. Douglas L. Packer, 4-416 Alfred Building, Mayo Foundation, Rochester, Minnesota 55905, USA.

OBJECTIVES: This study was designed to test the feasibility of high-resolution phased-array intracardiac imaging.

BACKGROUND: Intracardiac echocardiographic imaging of the heart during interventional electrophysiologic (EP) procedures has been limited by inadequate ultrasound penetration and absence of Doppler hemodynamic and flow information produced by rotating mechanical ultrasound elements.

METHODS: A 10F (3.2 mm) phased-array, variable 5.5 to 10 MHz frequency imaging catheter with a four-way deflectable tip was applied in 24 patients undergoing EP studies. Sixteen prespecified cardiac targets were imaged from a right heart venue.

RESULTS: Fifteen patients had no underlying organic heart disease; nine had ischemic, cardiomyopathic, valvular or congenital heart disorders. Longitudinal and short-axis imaging readily disclosed each cardiac valve, support structures and chamber, as well as the pericardium, right and left atrial appendages, the junction of the right atrium and superior vena cava, crista terminalis, tricuspid valve isthmus, coronary sinus orifice, membranous fossa ovalis and pulmonary veins. The average target depth was 8.8 ± 1.5 cm (range 0.5 to 15 cm), with adequate penetration at a 7.5 MHz imaging frequency. Color flow and Doppler utilities clearly characterized transaortic and pulmonic valve and pulmonary vein blood flow, including during low output states.

CONCLUSIONS: These first human studies with this technology demonstrate the methods, feasibility and utility of intracardiac phased-array vector and Doppler imaging for long-axis, apex-to-base global cardiac imaging. High resolution of endocardial structures and catheters suggests additional utility for visualizing interventional procedures from the right heart.

Abbreviations and Acronyms   SVC   EP   electrophysiologic, electrophysiology   IVC   inferior vena cava   LA   left atrium   LV   left ventricle   RA   right atrium   RV   right ventricle   SVC   superior vena cava

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