Transpericardial 3D Echocardiography in the Sheep Model, Facilitating Real Time Anatomical Assessment for Planning and G
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Cardiovascular Engineering and Technology (Ó 2020) https://doi.org/10.1007/s13239-020-00491-x
Original Article
Transpericardial 3D Echocardiography in the Sheep Model, Facilitating Real Time Anatomical Assessment for Planning and Guiding Transcatheter Mitral Valve Replacement and Repair AVI AVNER
,1 ITAI SABBAG,2 and EHUD RAANANI3
1
Knowledge Farm Diagnostic Imaging Center, PO Box 136, 30900 Zichron Yaakov, Israel; 2Lahav Research Institute, Kibutz Lahav, Israel; and 3Cardiothoracic Surgery Department, Sheba Medical Center, Tel Hasomer, Israel (Received 19 May 2020; accepted 24 September 2020) Associate Editor Pedro del Nido oversaw the review of this article.
Abstract Introduction—Symptomatic mitral regurgitation (MR) is associated with high morbidity and mortality which can be ameliorated by surgical valve replacement or repair. Despite this, many patients are excluded from surgery. Transcatheter mitral repair and replacement has emerged as a promising therapeutic option for the treatment of severe MR. The majority of these procedures rely on high definition three dimensional (3D) transesophageal echocardiographic (TEE) real time imaging. The sheep model is the model of choice for preclinical studies of transcatheter mitral valve (MV) replacement and repair. However due to the thoracic conformation TEE studies in those animals are suboptimal. Methods and Results—In this study we tested and compared the feasibility of conventional TEE and newly described transpericardial 3D echocardiography (TPE) for assessment of the MV as a tool to plan and possibly guide transcatheter/transapical procedures in the sheep model. The conventional TEE was challenging and produced incomplete data in all of the animals. In contrast, the TPE method clearly depicted the left atria and ventricle, MV apparatus, LVOT, aortic valve and proximal ascending aorta facilitating high resolution 3D rendering in all of the animals. Conclusion—The value of TEE in the sheep model is limited and could not be reliable for complete assessment of the LV and mitral valve apparatus. Whereas, TPE produce reliable and similar imaging to TEE in the human patients which could allow animal testing of devices designed to be delivered in humans. Keywords—Transesophageal 3D echocardiography, Mitral interventions, Ovine animal model.
Address correspondence to Avi Avner, Knowledge Farm Diagnostic Imaging Center, PO Box 136, 30900 Zichron Yaakov, Israel. Electronic mail: [email protected]
ABBREVIATIONS TPE TEE MR MV LV 3D LA LVOT PMs AAP LVB CS OF
Transpericardial echocardiography Transesophageal echocardiography Mitral regurgitation Mitral valve Left ventricle Three dimensional Left atrium Left ventricular outflow tract Papillary muscles Auricular appendage Left ventricular band Coronary sinus Oval fossa
INTRODUCTION Mitral regurgitation (MR) is the most prevalent form of valve disease in Western countries. The current estimated prevalence of moderate to severe MR in the United State is 2 to 2.5 million, and is expected that this number will rise to 5 mil
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