Myocardial microvasculature and haemodynamics are indicative of potential microvascular diseases for patients with symptoms of coronary heart disease in the absence of obstructive coronary arteries. However, imaging microvascular structure and flow within the myocardium is challenging owing to the small size of the vessels and the constant movement of the patient’s heart. Here we show the feasibility of transthoracic ultrasound localization microscopy for imaging myocardial microvasculature and haemodynamics in explanted pig hearts and in patients in vivo. Through a customized data-acquisition and processing pipeline with a cardiac phased-array probe, we leveraged motion correction and tracking to reconstruct the dynamics of microcirculation. For four patients, two of whom had impaired myocardial function, we obtained super-resolution images of myocardial vascular structure and flow using data acquired within a breath hold. Myocardial ultrasound localization microscopy may facilitate the understanding of myocardial microcirculation and the management of patients with cardiac microvascular diseases.

对于没有阻塞性冠状动脉的冠心病症状患者来说，心肌微血管和血流动力学表明潜在的微血管疾病。然而，由于血管尺寸较小且患者心脏不断运动，对心肌内的微血管结构和血流进行成像具有挑战性。在这里，我们展示了经胸超声定位显微镜对移植猪心脏和患者体内心肌微血管和血流动力学进行成像的可行性。通过使用心脏相控阵探头的定制数据采集和处理流程，我们利用运动校正和跟踪来重建微循环的动态。对于四名患者（其中两名心肌功能受损），我们使用屏气期间获取的数据获得了心肌血管结构和血流的超分辨率图像。心肌超声定位显微镜可能有助于了解心肌微循环和治疗心脏微血管疾病患者。