Live xPlane Imaging Research Articles

A new dimension in patent foramen ovale size estimation.

Detailed multidimensional assessment of patent foramen ovale (PFO) size with transesophageal echocardiography (TOE) may help to determine PFO pathogenicity in cryptogenic stroke patients. We explored the potential additive value of Live xPlane and three-dimensional (3D) TOE anatomical PFO sizing techniques. Imaging data of 45 patients who underwent a 3D TOE-assisted percutaneous PFO closure were studied. The two-dimensional (2D) PFO separation distance and right-to-left (RL) contrast shunt magnitude were assessed on preprocedural TOE recordings. Peri-procedural measurements of the triangular anatomical PFO opening (base, height, and area) were performed after positioning of a stiff guidewire (SW) through the PFO, using Live xPlane imaging and 3D Zoom mode. The PFO SW base appeared on average 5 times larger than the preprocedural 2D PFO separation (median difference [IQR]=13[5]mm; P<.001). For a same PFO separation, the width of the PFO base may vary significantly. The PFO SW base was significantly larger in patients with a large versus a small-to-moderate PFO RL contrast shunt (18 vs 15mm; P=.007) and in those with a spontaneous versus a provoked shunt (18 vs 14mm; P=.003). Live xPlane and 3D Zoom TOE allow peri-procedural measurement of the largest dimension of a PFO, which is the PFO base. Patients with a large or spontaneous RL contrast shunt appear to have a larger PFO base. The anatomical PFO base dimension may be taken into account for optimization of device and patient selection strategies.

P1563 A new dimension in patent foramen ovale size estimation

Abstract Introduction Detailed multidimensional assessment of patent foramen ovale (PFO) size with transesophageal echocardiography (TOE) may help to determine PFO pathogenicity in cryptogenic stroke patients and may improve the procedural outcome of percutaneous PFO closure. Purpose We explored the potential additive value of Live xPlane and three-dimensional (3D) TOE anatomical PFO sizing techniques. Methods Imaging data of 45 patients who underwent a 3D TOE-assisted PFO closure were included. The two-dimensional (2D) PFO separation distance and right to left (RL) contrast shunt magnitude were retrospectively assessed at rest and during release of a Valsalva maneuver on pre‑procedural 2D TOE recordings. Peri-procedural measurements of the triangular anatomic PFO opening (base, height and area) were performed after positioning of a stiff guidewire (SW) through the PFO, using Live xPlane imaging and 3D Zoom mode. Results The peri-procedural PFO SW base was on average five times larger than the pre-procedural 2D PFO separation (median difference +/- IQR : 13 +/- 5 mm ; p &amp;lt; 0.001), having the biggest impact on total PFO area. The width of the PFO SW base was highly variable, even for a given separation, and significantly larger in patients with a large versus a small to moderate PFO RL contrast shunt (18 versus 15 mm; p = 0.007) and in those with a spontaneous versus a provoked shunt (18 versus 14 mm; p = 0.003). Conclusion The PFO SW base, assessed by Live xPlane and 3D TOE, seems a more precise estimate of anatomical PFO size compared to the conventional 2D PFO separation distance. This new PFO dimension may be taken into account for optimization of device and patient selection strategies. Abstract P1563 Figure. 3D Zoom PFO size measurement

2D versus 3D real time ultrasound with live xPlane imaging to visualize aortic and ductal arches: comparison between methods.

BackgroundThe diagnosis of congenital heart defects is challenging, especially for what concerns conotruncal anomalies. Indeed, although the screening techniques of fetal cardiac anomalies have greatly improved, the detection rate of conotruncal anomalies still remains low due to the fact that they are associated with a normal four-chamber view. Therefore, the study aimed to compare real-time three-dimensional echocardiography with live xPlane imaging with two-dimensional (2D) traditional imaging in visualizing ductal and aortic arches during routine echocardiography of the second trimester of gestation.MethodsThis was an observational prospective study including 114 women with uncomplicated, singleton pregnancies. All sonographic studies were performed by two different operators, of them 60 by a first level operator, while 54 by a second level operator. A subanalysis was run in order to evaluate the feasibility and the time needed for the two procedures according to fetal spine position and operator’s experience.ResultsThe measurements with 2D ultrasound were performed in all 114 echocardiographies, while live xPlane imaging was feasible in the 78% of the cases, and this was mainly due to fetal position. The time lapse needed to visualize aortic and ductal arches was significantly lower when using 2D ultrasound compared to live xPlane imaging (29.56 ± 28.5 s vs. 42.5 ± 38.1 s, P = 0.006 for aortic arch; 22.14 ± 17.8 s vs. 37.1 ± 33.8 s, P = 0.001 for ductal arch), also when performing a subanalysis according to operators’ experience (P < 0.05 for all comparisons). Feasibility of live xPlane proved to be correlated with the position of the fetal spine and the operator’s experience.DiscussionTo find a reproducible and standardized method to detect fetal heart defects may bring a great benefit for both patients and operators. In this scenario live xPlane imaging is a novel method to visualize ductal and aortic arches. We found that the position of the fetal spine may affect the feasibility of the method since, when the fetal back is anterior or transverse, the visualization of the correct view of three-vessels and trachea in order to set the reference line properly becomes more challenging. In addition, the fetal spine position influences the duration of the ultrasound examination. Regarding operator’s skills and experience, in our study a first level operator was able to perform the complete 2D and xPlane examination in a lower number of cases compared to second level operators. In addition, the time required for the complete examination was higher for first level operators. This means that this technique is based on an adequate operators’ expertise.

Visualization and quantitation of fetal movements by real-time three-dimensional ultrasound with live xPlane imaging in the first trimester of pregnancy.

AimTo prove whether real-time three-dimensional (3D) ultrasound with live xPlane imaging is better in observing fetal movements than standard ultrasound imaging.Methods50 healthy women with singleton pregnancies (22-43 years old) at 11 to 14 weeks of gestation underwent real-time 3D ultrasound examination with live xPlane imaging from July 2014 to February 2015. The incidence and frequency of 10 fetal movement patterns in 10 minutes were evaluated, including general movements (GMs), isolated arm movements, isolated leg movements, hiccup, stretching, breathing, startle, jaw opening, isolated head retroflexion, and isolated head anteflexion. The correlation between gestational age and frequency of each fetal movement pattern was analyzed.ResultsGM had the highest incidence (100%), followed by startle (84%) and isolated arm movements (68%). Their median frequency was 5 (IQR 3-6), 5 (IQR 1.75-11.5), and 1 (IQR 0-2), respectively. GM (Z = 5.875, P < 0.001) and startle (Z = 5.302, P < 0.001) had significantly higher frequency than isolated arm movements. The other 7 fetal movement patterns had much lower incidence and frequency. The frequency of GM was positively correlated with gestational age (r = 0.360, P = 0.010).ConclusionReal-time 3D ultrasound with live x Plane imaging was shown to be a feasible tool for observing fetal movements.

Detection of the fetal conotruncal anomalies using real‐time three‐dimensional echocardiography with live xPlane imaging of the fetal ductal arch view

To evaluate the role of live xPlane imaging of ductal arch view in detection of fetal conotruncal anomalies. Two hundred selected singleton pregnancies, including 152 normal cases, 27 conotruncal anomalies and 21 other types of fetal heart abnormalities were enrolled in this observational study. All the cases were scanned to visualize the ductal arch view with live xPlane imaging by a single observer. The detection rate of conotruncal and non-conotruncal anomalies with live xPlane imaging was compared. In using this new method of live xPlane imaging, an abnormal ductal arch view was visualized in 92.6% of fetal conotruncal anomalies, compared with that of non-conotruncal anomalies (23.8%, p < 0.001). The ductal arch view can be obtained by live xPlane imaging. This method is relatively simple and feasible, hence may be a useful tool to detect fetal conotruncal anomalies.

Can live xPlane imaging of the in-plane view of interventricular septum be used to detect fetal conotruncal anomalies?

Objective: To evaluate the feasibility of live xPlane imaging visualizing the in-plane view of IVS in the screening of the fetal conotruncal anomalies. Method: One hundred and fifty-two consecutive normal singleton fetuses and forty-eight fetal cardiac defects (27 conotruncal and 21 non-conotruncal cases), were enrolled in this study. The in-plane view of IVS was firstly acquired with live xPlane imaging and then judged whether it is normal or not by one operator. The focus was put on observing the relationship of pulmonary artery and aorta. The comparison between conotruncal and non-conotruncal anomalies in demonstrating the relationship of pulmonary artery and aorta was performed. Result: There were 27 cases of conotruncal anomalies enrolled in this study and 19 cases (70.4%) had the abnormal relationship of aorta and pulmonary artery in the in-plane view of IVS. In 21 cases of non-conotruncal CHDs, however, there were only 5 cases (23.8%) had the abnormal relationship in the in-plane view of IVS (p < 0.001). Conclusion: Live xPlane imaging of the in-plane view of IVS is feasible to detect the fetal conotruncal anomalies, which may potentially be a useful tool for the non-experienced operators to screen the fetal conotruncal anomalies.

A novel way of visualizing the ductal and aortic arches by real‐time three‐dimensional ultrasound with live xPlane imaging

To describe a novel method of visualizing the ductal and aortic arches by real-time three-dimensional echocardiography with live xPlane imaging. Live xPlane imaging was used to display the ductal- and aortic-arch views in 107 women with singleton pregnancies, including seven cases with suspected congenital heart defects (CHDs). The three vessels and trachea (3VT) view was obtained in such an orientation that either the pulmonary artery or the aorta was parallel to the direction of the ultrasound beam. The xPlane reference line was then placed across the targeted vessel, which in a normal case would provide an image of the corresponding arch view as a dual-image display. Once the 3VT view had been obtained, live xPlane imaging showed the aortic and ductal arches in all 100 normal cases. In seven cases with suspected CHD, the 3VT view was abnormal in five cases and normal in the other two. However, the ductal-arch view demonstrated by live xPlane imaging was abnormal in five cases of conotruncal anomalies and normal in two cases in which conotruncal anomalies were excluded. CHDs were confirmed at autopsy following termination of pregnancy in five cases and on postnatal echocardiography in one case. The heart was found postnatally to be normal in one case of suspected CHD; in this case live xPlane imaging showed that the observed abnormal 3VT view was caused by a tortuous course of the thoracic aorta associated with an abnormal diaphragm. Live xPlane imaging is a novel and relatively simple method of visualizing the ductal- and aortic-arch views, and may potentially be a useful tool in the screening of fetal conotruncal and aortic-arch anomalies.

OP15.05: A novel way to visualize the ductal arch and aortic arch by real‐time three‐dimensional ultrasound with live xPlane imaging

OP15.05: A novel way to visualize the ductal arch and aortic arch by real‐time three‐dimensional ultrasound with live xPlane imaging

Scan the fetal heart by real-time three-dimensional echocardiography with live xPlane imaging

Objective. To describe the methodology of live xPlane imaging in the visualization of the fetal heart in detail.Methods. Fifty-one consecutive pregnant women with singleton pregnancies were imaged to display four screening sections of the fetal heart, the four-chamber view, the left outflow tract view (LVOT), the right outflow tract view (RVOT), and the three-vessel and trachea view (3VT), using live xPlane imaging. The methodology of how to visualize the screening planes was described in detail. We used two methods to image the fetal heart with live xPlane imaging: one uses the four-chamber view as the starting plane and the other uses the longitudinal view of fetal upper thorax as the starting plane.Results. When using the four-chamber view as the starting plane, the visualization rate of LVOT, RVOT, and 3VT was 94.1% (48/51), 100% (51/51), and 98.0% (50/51), respectively. When using the longitudinal view as the starting plane, the visualization rate of four-chamber view, LVOT, RVOT, and 3VT was 100% (51/51), 100% (51/51), 41.2% (21/51), and 100% (51/51), respectively.Conclusions. Live xPlane imaging can be used to visualize the screening views of the fetal heart, and potentially may be a useful tool for the assessment and diagnosis of fetal congenital heart diseases.

Real‐time three‐dimensional ultrasound with Live xPlane imaging assists first‐trimester acquisition of a true midsagittal section

To determine whether real-time three-dimensional (3D) ultrasound with Live xPlane imaging, which enables the simultaneous display of two real-time high-quality image planes, can assist both operators certified by The Fetal Medicine Foundation (FMF) and non-FMF-certified operators in acquiring a true midsagittal plane in the first trimester. Eight operators, four of them FMF certified (FMF group) and the other four not (non-FMF group), were asked to acquire a fetal image that they believed to represent the true midsagittal plane using real-time 3D ultrasound with Live xPlane imaging as guidance. Each operator was asked to obtain such an image five times from each of five patients. A total of 200 images from 40 patients were obtained and stored for subsequent analysis. All pregnancies were between 11 + 0 and 13 + 6 weeks of gestation. The angle between the falx cerebri and vertical axis (angle of deviation) was then measured by a single operator. A true midsagittal section was defined as an angle of deviation equal to 0 degrees. The angle of deviation and the time taken to acquire each image were compared between FMF and non-FMF groups. The median angle of deviation for each operator ranged from 1.2 degrees to 3.4 degrees. There was no significant difference in this angle between those who were FMF certified and those who were not (2.0 degrees vs. 2.2 degrees, P = 0.463). The interquartile range of the angle of deviation was also similar between the FMF- and non-FMF-certified operators. Although the time taken for image acquisition was longer among the non-FMF-certified operators (median, 45.5 s vs. 32.0 s), this difference did not reach statistical significance (P = 0.107). Live xPlane imaging can provide a tool to assist the acquisition of a true midsagittal plane and to determine how true a 'midsagittal' plane really is.

Assessment of the fetal interventricular septum using real‐time three‐dimensional echocardiography with Live 3D imaging

Assessment of the fetal interventricular septum using real‐time three‐dimensional echocardiography with Live 3D imaging

Real‐time three‐dimensional echocardiography using a matrix probe with live xPlane imaging of the interventricular septum

To describe a technique to rapidly visualize the in-plane view of the fetal interventricular septum (IVS) to enable the identification of a ventricular septal defect (VSD). One hundred and fifty-one women were invited to participate after their routine fetal morphology scan, including four suspected to have congenital cardiac defects which were confirmed postnatally. A standard examination protocol using real-time three-dimensional (3D) echocardiography with live xPlane imaging was developed. The ability of this new technology to examine the ventricular septum was investigated. The in-plane view of the fetal IVS was visualized successfully in 150 (99.3%) cases by real-time 3D echocardiography with live xPlane imaging, including 82 (54.3%) cases with the spine posterior and 68 (45.7%) cases with the spine anterior. The in-plane view of the IVS successfully visualized the VSDs in three fetuses with VSD and displayed the intact IVS in one fetus with transposition of the great arteries without VSD. We describe live xPlane imaging, a simple method for the real-time assessment of the in-plane view of the IVS that has the potential to enhance the diagnostic accuracy of fetal cardiac examination.

OP02.01: Real-time three-dimensional ultrasound in assisting the acquisition of a true midsagittal section using a matrix probe with Live xPlane Imaging

OP02.01: Real-time three-dimensional ultrasound in assisting the acquisition of a true midsagittal section using a matrix probe with Live xPlane Imaging

P24.02: Real-time three-dimensional echocardiography using a matrix probe with live xPlane imaging directed at the interventricular septum

P24.02: Real-time three-dimensional echocardiography using a matrix probe with live xPlane imaging directed at the interventricular septum