Three-dimensional echocardiography-guided atrial septectomy: an experimental study.

Yoshihiro Suematsu; Gerald R Marx; John K Triedman; Tomislav Mihaljevic; Bassem N Mora; Shinichi Takamoto; Pedro J del Nido

doi:10.1016/j.jtcvs.2004.03.008

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Three-dimensional echocardiography-guided atrial septectomy: an experimental study.

Yoshihiro Suematsu·Gerald R Marx·John K Triedman·Tomislav Mihaljevic·Bassem N Mora·Shinichi Takamoto·Pedro J del Nido

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Abstract

OBJECTIVES: The surgical feasibility of beating-heart atrial septectomy under the guidance of two different types of real-time 3-dimensional echocardiography systems was examined. METHODS: A modified real-time 3-dimensional echocardiography system with a x4 matrix transducer (Sonos 7500; Philips Medical Systems, Andover, Mass) or a mechanical 1-dimensional array transducer (SSD-5500; Aloka Co, Ltd, Tokyo, Japan) was used. Small porcine atrial septal defects (n = 8) were enlarged with a Kerrison bone punch in the tank model. In the animal studies, small atrial septal defects (n = 8) were enlarged with the same device through a transatrial port. In both experiments, the area of the atrial septal defect measured by real-time 3-dimensional echocardiography was compared with the area measured directly. RESULTS: Real-time 3-dimensional echocardiography provided satisfactory images and sufficient anatomic detail for the atrial septectomy in both experimental settings. All the atrial septal defects were successfully enlarged; an increase of as much as 293% of the preoperative atrial septal defect area was achieved in the tank experiment, and an increase of as great as 449% of the preoperative area was achieved in the animal experiment. The size of the atrial shunt was increased significantly after the atrial septectomy relative to that before the surgery (P <.0001). The percentage enlargement of the atrial septal defect measured by real-time 3-dimensional echocardiography was strongly correlated with that measured directly (both r(2) = 0.997, P <.0001) Bland-Altman analysis showed close agreement between the results obtained by the two measurement methods in both models. CONCLUSIONS: Real-time 3-dimensional echocardiography provides satisfactory images and sufficient anatomic detail for atrial septectomy. This experiment demonstrates the surgical feasibility of a beating-heart intracardiac procedure such as atrial septectomy under real-time 3-dimensional echocardiographic guidance.

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Animals Cardiac Surgical Procedures Computer Systems Coronary Vessels Disease Models, Animal Dogs Echocardiography, Three-Dimensional Equipment Design Heart Atria Heart Septal Defects, Atrial Heart Septum Models, Cardiovascular Swine Tricuspid Valve Comparative Study Evaluation Study Journal Article Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

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Yoshihiro Suematsu, Gerald R Marx, John K Triedman, Tomislav Mihaljevic, Bassem N Mora, Shinichi Takamoto, Pedro J del Nido. 2004. Three-dimensional echocardiography-guided atrial septectomy: an experimental study.. https://doi.org/10.1016/j.jtcvs.2004.03.008

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