Background

Radiation reduction is desirable in children undergoing cardiac catheterization. Three-dimensional (3D) transesophageal echocardiographic (3D TEE) imaging obviates the need for mental reconstruction of 3D structures from two-dimensional images. Three-dimensional TEE imaging is used in atrial septal defect (ASD) closures. Three-dimensional TEE guidance of right heart catheterization (RHC) without fluoroscopy for ASD closures has not been demonstrated. The aim of this study was to evaluate the feasibility of 3D TEE guidance of RHC in ASD closures and radiation reduction compared with historical control subjects.

Methods

Twenty-two patients underwent 3D TEE guidance of RHC and ASD closures and were compared with 44 control subjects. RHC time, total fluoroscopy time, radiation dose, and procedural time were compared. Fluoroscopy time during RHC was recorded in patients undergoing 3D TEE guidance.

Results

There was a 54% reduction in total fluoroscopy time and a 78% radiation reduction demonstrated with 3D TEE guidance of patients with ASDs compared with control subjects. Although there were no statistically significant differences in the RHC time compared with control subjects, the fluoroscopy time (mean, 0.06 ± 0.23 min) for RHC guidance using 3D TEE imaging was almost zero. There was decreased RHC time as we progressed through the learning curve of performing 3D TEE guidance of RHC (r = −0.63, P < .01). There were no statistically significant differences in total procedural time.

Conclusions

Three-dimensional TEE guidance in RHC is feasible without the use of fluoroscopy and reduces radiation exposure in percutaneous ASD closures. Three-dimensional TEE guidance may be used in other interventional procedures in the future to further reduce radiation exposure and facilitate catheter interventions.

中文翻译：

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右心导管的三维超声心动图指导减少了房间隔缺损闭合处的辐射暴露。

背景

在进行心脏导管检查的儿童中，希望减少辐射。三维（3D）经食道超声心动图（3D TEE）成像消除了从二维图像对3D结构进行心理重建的需要。三维TEE成像用于房间隔缺损（ASD）闭合。右心导管（RHC）的三维TEE引导无需透视即可进行ASD封闭的透视检查，但尚未得到证实。这项研究的目的是评估与历史对照受试者相比，RHC在ASD闭合和辐射减少方面的3D TEE指导的可行性。

方法

22名患者接受了RHC和ASD封闭的3D TEE指导，并与44名对照对象进行了比较。比较了RHC时间，总透视时间，放射剂量和手术时间。在接受3D TEE指导的患者中，记录了RHC期间的透视时间。

结果

与对照组相比，在3D TEE指导下，ASD患者的总透视时间减少了54％，放射减少了78％。尽管与对照组相比，RHC时间没有统计学上的显着差异，但是使用3D TEE成像进行RHC指导的透视时间（平均0.06±0.23分钟）几乎为零。随着我们逐步完成执行RHC的3D TEE指导的学习曲线，RHC时间减少了（r  = -0.63，P  <.01）。总手术时间没有统计学上的显着差异。

结论

在不使用荧光检查的情况下，在RHC中进行三维TEE指导是可行的，并且可以减少经皮ASD闭合中的辐射暴露。将来，三维TEE指南可用于其他介入程序，以进一步减少辐射暴露并促进导管介入。