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2.
Pediatr Cardiol ; 39(3): 538-547, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29181795

RESUMO

Mastering the technical skills required to perform pediatric cardiac valve surgery is challenging in part due to limited opportunity for practice. Transformation of 3D echocardiographic (echo) images of congenitally abnormal heart valves to realistic physical models could allow patient-specific simulation of surgical valve repair. We compared materials, processes, and costs for 3D printing and molding of patient-specific models for visualization and surgical simulation of congenitally abnormal heart valves. Pediatric atrioventricular valves (mitral, tricuspid, and common atrioventricular valve) were modeled from transthoracic 3D echo images using semi-automated methods implemented as custom modules in 3D Slicer. Valve models were then both 3D printed in soft materials and molded in silicone using 3D printed "negative" molds. Using pre-defined assessment criteria, valve models were evaluated by congenital cardiac surgeons to determine suitability for simulation. Surgeon assessment indicated that the molded valves had superior material properties for the purposes of simulation compared to directly printed valves (p < 0.01). Patient-specific, 3D echo-derived molded valves are a step toward realistic simulation of complex valve repairs but require more time and labor to create than directly printed models. Patient-specific simulation of valve repair in children using such models may be useful for surgical training and simulation of complex congenital cases.


Assuntos
Ecocardiografia Tridimensional/métodos , Valva Mitral/diagnóstico por imagem , Modelos Anatômicos , Impressão Tridimensional , Valva Tricúspide/diagnóstico por imagem , Criança , Ecocardiografia Tridimensional/economia , Humanos , Estudos Retrospectivos , Treinamento por Simulação
3.
Int J Cardiol ; 198: 15-21, 2015 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-26149331

RESUMO

Over the years echocardiography has served the clinical cardiologist in a variety of clinical scenarios, assisting in patient diagnostic and therapeutic managements. With the advent of novel imaging modalities we now experience the renascence of imaging. As a result, the field of cardiovascular medicine is strongly connected to imaging, which in turn requires thorough knowledge of each modality's distinct advantages and limitations. In this concise review we present up-to-date knowledge with regard to real-time three-dimensional echocardiography and its implementation in clinical practice.


Assuntos
Ecocardiografia Tridimensional/métodos , Cardiopatias/diagnóstico por imagem , Ecocardiografia Tridimensional/economia , Valvas Cardíacas/anatomia & histologia , Valvas Cardíacas/diagnóstico por imagem , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Aumento da Imagem/métodos , Reprodutibilidade dos Testes , Software , Resultado do Tratamento
4.
Circ Cardiovasc Imaging ; 7(1): 115-24, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24192452

RESUMO

BACKGROUND: Placebo-controlled trials for pulmonary arterial hypertension are no longer acceptable because new therapies must show clinically significant effects on top of standard treatment. The purpose of this study was to estimate sample sizes and imaging costs for the planning of a hypothetical pulmonary arterial hypertension drug trial using imaging to detect changes in right ventricular size and function in response to combined therapy. METHODS AND RESULTS: Same-day cardiovascular MR (CMR) and 2-dimensional (2D) and 3D transthoracic echocardiography (2DTTE and 3DTTE) were performed in 22 patients with pulmonary arterial hypertension (54±13 years of age) twice, 6 months apart. Short-axis CMR cines and full-volume 3DTTE data sets of the right ventricle were used to measure end-diastolic volume and ejection fraction. Fractional area change was obtained from 2DTTE. Sample size calculations used a 2-sample t test model incorporating differences between baseline and 6-month measurements. Cost estimates were made using the Medicare fee schedule. No significant differences were noted between baseline and follow-up measurements. Large SDs reflected variable progression of disease in individual patients on standard therapy and measurement variability. These sources of variability resulted in intertechnique differences in sample sizes: to detect a change of 5% to 15% in 3DTTE-derived right ventricular ejection fraction and fractional area change or change of 15 to 30 mL in 3DTTE right ventricular end-diastolic volume; sample sizes were 2× to 2.5× those required by CMR. As a result, the total cost of a trial using complete TTE was greater than CMR, which was greater than limited TTE. CONCLUSIONS: Because of lower measurement variability, CMR is more cost saving in pulmonary arterial hypertension drug trials than echocardiography, unless limited TTE is used.


Assuntos
Anti-Hipertensivos/uso terapêutico , Ensaios Clínicos Controlados como Assunto/economia , Diagnóstico por Imagem/economia , Custos de Cuidados de Saúde , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/economia , Tamanho da Amostra , Função Ventricular Direita/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Análise Custo-Benefício , Quimioterapia Combinada , Ecocardiografia Tridimensional/economia , Hipertensão Pulmonar Primária Familiar , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Imagem Cinética por Ressonância Magnética/economia , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Valor Preditivo dos Testes , Resultado do Tratamento
5.
Eur Heart J ; 31(19): 2326-37, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20709721

RESUMO

Biventricular pacing or cardiac resynchronization therapy (CRT) has been a considerable advance in the therapy of chronic heart failure. However, it is clear that not all patients benefit either in terms of symptoms or cardiac function, and some may be worsened by CRT. In this review, we consider the arguments, both clinical and economical, in favour of improved selection of patients for CRT other than those in current guidelines. It also seems clear that the fundamental mechanism of CRT is correction of dyssynchrony, and we review the various methodologies available to detect dyssynchrony. Other factors are probably also important in determining outcomes such as lead position, the extent and form of myocardial damage, optimizing pacemaker performance, and clinical expertise. The potential costs of inappropriate CRT implantation are high to our patients and to the health economy, and it behooves the cardiology community to develop better selection criteria. The current guidelines can and should be improved.


Assuntos
Arritmias Cardíacas/terapia , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/economia , Terapia de Ressincronização Cardíaca/economia , Ecocardiografia Doppler/economia , Ecocardiografia Doppler/métodos , Ecocardiografia Tridimensional/economia , Ecocardiografia Tridimensional/métodos , Previsões , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/economia , Humanos , Falha de Tratamento
7.
J Interv Cardiol ; 21(6): 535-46, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18973503

RESUMO

Percutaneous techniques to treat structural heart disease are rapidly evolving based on innovative interventions and the considerable advancement in image guidance technology. While two-dimensional transthoracic and transesophageal echocardiography have been integral to procedural planning and execution, intracardiac and three-dimensional echocardiography supply unique visualization of target structures with a potential improvement in patient safety and procedural efficacy. The choice of image guidance modality is based on specific differences between imaging systems, as well as other variables including cost, patient safety, operator expertise, and complexity of procedure. We will compare the adjunctive imaging tools for structural heart disease interventions, with a focus on intracardiac echocardiography and real-time three-dimensional transesophageal echocardiography.


Assuntos
Cateterismo Cardíaco/métodos , Ecocardiografia Doppler/métodos , Ecocardiografia Tridimensional/métodos , Cardiopatias/diagnóstico por imagem , Ecocardiografia Doppler/economia , Ecocardiografia Tridimensional/economia , Comunicação Interventricular/diagnóstico por imagem , Humanos
9.
Circulation ; 114(7): 654-61, 2006 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-16894035

RESUMO

BACKGROUND: Cardiac CT (CCT) and real-time 3D echocardiography (RT3DE) are being used increasingly in clinical cardiology. CCT offers superb spatial and contrast resolution, resulting in excellent endocardial definition. RT3DE has the advantages of low cost, portability, and live 3D imaging without offline reconstruction. We sought to compare both CCT and RT3DE measurements of left ventricular size and function with the standard reference technique, cardiac MR (CMR). METHODS AND RESULTS: In 31 patients, RT3DE data sets (Philips 7500) and long-axis CMR (Siemens, 1.5 T) and CCT (Toshiba, 16-slice MDCT) images were obtained on the same day without beta-blockers. All images were analyzed to obtain end-systolic and end-diastolic volumes and ejection fractions using the same rotational analysis to eliminate possible analysis-related differences. Intertechnique agreement was tested through linear regression and Bland-Altman analyses. Repeated measurements were performed to determine intraobserver and interobserver variability. Both CCT and RT3DE measurements resulted in high correlation (r2 > 0.85) compared with CMR. However, CCT significantly overestimated end-diastolic and end-systolic volumes (26 and 19 mL; P < 0.05), resulting in a small but significant bias in ejection fraction (-2.8%). RT3DE underestimated end-diastolic and end-systolic volumes only slightly (5 and 6 mL), with no significant bias in EF (0.3%; P = 0.68). The limits of agreement with CMR were comparable for the 2 techniques. The variability in the CCT measurements was roughly half of that in either RT3DE or CMR values. CONCLUSIONS: CCT provides highly reproducible measurements of left ventricular volumes, which are significantly larger than CMR values. RT3DE measurements compared more favorably with the CMR reference, albeit with higher variability.


Assuntos
Ecocardiografia Tridimensional , Ventrículos do Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Idoso , Ecocardiografia Tridimensional/economia , Ecocardiografia Tridimensional/métodos , Feminino , Ventrículos do Coração/patologia , Humanos , Modelos Lineares , Imageamento por Ressonância Magnética/economia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Software , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/métodos , Função Ventricular Esquerda
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