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1、CartoSound CartoSound 在房性心律失常中的应用在房性心律失常中的应用工欲善其事 必先利其器CartoSound 在房性心律失常中的应用在房性心律失常中的应用对心房结构的认识对心房结构的认识ICEICE指导下的房间隔穿刺指导下的房间隔穿刺CartoSoundCartoSound下的左房建模与消融下的左房建模与消融食道位置的识别食道位置的识别并发症的监测并发症的监测CartoSoundCartoSound在右房中的应用在右房中的应用Fossa Ovalis Fossa Ovalis View From the LAA view, small movements (clockwi
2、se or counter clockwise) will optimize the fossa ovalis view. You may have to advance the catheter slightly in order to center the view. In preparation for guidance of the transseptal puncture (TSP) from this view, it may be necessary to engage the tension or lock function on the catheter. Also, use
3、 some posterior tilt and possibly right steering to optimize the fossa. Left Atrial Appendage View The left atrial appendage (LAA) is seen in a similar plane to that of the Left Pulmonary Veins. The LAA is visualized using further clockwise rotation. The IAS, MV and LAA will usually come into view.
4、The LAA is often visualized in the same plane as the mitral valve and will appear as an “out-pouching” from the LA.Left Atrial Appendage Left Pulmonary Veins From the fossa view, you may need to disengage steering and rotate slightly clockwise. The left inferior pulmonary vein (LIPV) and left superi
5、or pulmonary vein (LSPV) are usually seen in the same plane. Utilize color Doppler to assist with identifying the pulmonary veins. Left Pulmonary Veins Right Pulmonary Veins From the left veins continue clockwise rotation.The right inferior pulmonary vein (RIPV) and the right superior pulmonary vein
6、 (RSPV) will appear close to the imaging surface of the ACUNAV image. In order to view the right superior pulmonary vein (RSPV) more longitudinally, advance the catheter and continue clockwise rotation. In many cases the addition of anterior tilt and right/left steering at this time will further opt
7、imize the image. Right Pulmonary Veins ansverseSinusTRANSVERSE SINUSThe third party trademarks used herein are trademarks of their respective ownersCavo Tricuspid Isthmus Cavo Tricuspid Isthmus View The isthmus view can be obtained by rotating the ACUNAV catheter clockwise from the crista view back
8、to the “Home Position” view. Once this view is obtained, withdraw the ACUNAV catheter out of the patient slightly. This will allow an image of the eustachian ridge to be visualized. The isthmus is the area between the eustachian ridge and the tricuspid valve. The third party trademarks used herein a
9、re trademarks of their respective ownersCrista Terminalis View from the “Home Position,” rotate the ACUNAV catheter counter clockwise, or towards the patients right. The crista is an anterior structure, so the imaging face of the ACUNAV catheter is being rotated to look anteriorly . The crista is al
10、so a more superficial structure in relation to the ACUNAV imaging surface, so the “depth” knob may need to be adjusted to show only anatomical structures that are closer to the catheter. A common depth to focus the crista is 30-50 cm. Crista TerminalisThe third party trademarks used herein are trade
11、marks of their respective ownersAtrial Septal AbnormalitiesPatent Foramen Ovale (PFO)Small flap-like opening in the inter-atrial septum from fetal circulation1 in 4 people have a PFO that persists throughout lifeMost people have no symptomsPFO is associated with stroke A defect (hole) between the tw
12、o atriaSurgical vs. percutaneous repairAtrial Septal Defect (ASD)Septal Tunnel (PFO)Septal Tunnel (PFO)Atrial Septal DefectFenestratedAneurysmal Atrial SeptumICE指导下的房间隔穿刺更安全卵圆孔和穿刺针可视构建出相邻解剖结构减少x线使用盐水替代造影剂验证在三维壳上标记卵圆窝提高安全性和优化位置应对复杂穿刺情况保护患者和医生减少肾脏负荷方便导管回到左房三维超声下房间隔穿刺Tenting was called by TEE Do you se
13、e tenting with ACUNAV?Using ACUNAV to Guide Transseptal PunctureThe third party trademarks used herein are trademarks of their respective ownersTransseptal PunctureUsing ACUNAV to Guide Transseptal PunctureWhere did the needle end up?The third party trademarks used herein are trademarks of their res
14、pective owners使用肝素盐水替代造影剂验证Transseptal PunctureSOUNDSTAR构建左房三维模型SOUNDSTAR构建左房三维模型CartoSound左房建模SoundMap法CartoSound左房建模左房建模SoundMap+AF2.0CartoSound左房建模左房建模SoundMap +CT mergeAblation Catheter Visualization and LocationImproves physician confidence with real-time visualization of the exact location of
15、the ablation catheterClinical Benefits CARTOSOUNDCASECartoSound指导下的房颤消融（我院经验）患者，男性，患者，男性，6161岁岁病史：病史：Paroxysmal AF 5yParoxysmal AF 5y既往史：高血压既往史：高血压UCGUCG：LA 42mm LV 48mm RA 34mmLA 42mm LV 48mm RA 34mm LVEF 0.6 LVEF 0.6术前诊断：术前诊断：1.1.心律失常心律失常 阵发性房颤阵发性房颤 2.2.高血压病高血压病 3 3级（极高危）级（极高危） Creating SoundMapTr
16、ansseptal Puncture监视穿刺针的位置监视穿刺针的位置选择出针方向和力度选择出针方向和力度观察房间隔形态变化观察房间隔形态变化视觉结合手感判断是视觉结合手感判断是否穿过否穿过使用盐水替代造影剂使用盐水替代造影剂FAM vs. SoundMap大头详细FAM肺静脉可以代替定口超声指导：更真实的特殊结构 During Ablation-消融During Ablation 消融点分布LPV偏心耳侧消融模型轮廓和消融点有距离RPV后壁完美直观的勾勒肺静脉开口，指导消融 During Ablation-大头监视 During Ablation超声与三维影像实时对应消融点与大头在超声图上显影
17、EsophagusEsophageal LocalizationEsophageal Localization诊断LAA血栓SOUNDSTAR导管：耐受性好耐受性好RAARAA（位于右房）和（位于右房）和LAALAA图像质量高（位于肺动图像质量高（位于肺动脉）脉）TEETEE诊断心耳血栓，当：诊断心耳血栓，当：患者不能耐受患者不能耐受图像质量差时，图像质量差时，SOUNDSTAR是TEE的可靠替代手段CartoSound检查LAA血栓房间隔左房左心耳Callans DJ, Marchlinski FE, Ren JF. Left Atrial Thrombus Associated With
18、Ablation For Atrial Fibrillation: Identification With Intracardiac Echocardiography. JACC. May 19, 2004; 43(10):1861-7Monitor for ThrombusThrombus is identified in 10.3% of left-sided casesMonitor for ThrombusPericardial Effusion TamponadeCARTOSOUND在右房房扑和房速手术中的应用Atrial Flutter AblationTricuspid Isth
19、musCrista TerminalisRight Atrial MappingRight Atrial MappingRight Atrial MappingRight Atrial Flutter房扑：CTI解剖和Pouch位置Pouch位置在Pouch部位的消融PouchCTI导管位于Pouch房扑：判断导管在CTI在欧式嵴的贴靠情况导管未贴靠导管贴靠欧式嵴欧式嵴消融导管消融导管消融导管消融导管贴靠在贴靠在CTICARTOSOUND下的CTI消融方法复杂房速：发现未知复杂病例精确、自信辨别解剖结构适用于全心腔的标测策略总总 结结缩短电生理手术学习曲线提高手术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CARTOSOUND+SOUNDSTAR谢 谢
