Zoom Mode Research Articles

Endoscopic evaluation of gastric mucosal alterations in patients with chronic heart failure II-III nyha functional class utilizing advanced endoscopic techniques

Objective: To assess the alterations of gastric mucosa, its pathomorphological and functional characteristics in patients with complete erosions suffering from chronic heart failure II-III NYHA functional class. Materials and Methods: 185 patients with complete erosions comprised the main group, while the control group consisted of 183 patients with incomplete erosions of the stomach. Patients in both groups had chronic heart failure II-III NYHA functional class. All patients underwent esophagogastroduodenoscopy with white light imaging (WLI), narrow-band imaging (NBI), and ZOOM modes, as well as biopsy sampling followed by pathomorphological examination, determination of Helicobacter pylori presence, and endoscopic pH-metry. The diagnosis of chronic heart failure was established based on anamnestic data and the results of instrumental and functional diagnostic methods, including electrocardiography (ECG), echocardiography, Holter monitoring of ECG, stress echocardiography, and coronary angiography. Results: The study utilized the classification of gastric erosive lesions by K. Toljamo (2012), according to which in the main group, mature erosions subtype Ia were detected in 83.8% of cases, while immature extensive erosions subtype Ib were found in 16.2%. In combination with haemorrhagic erosions (type III), complete erosions were detected in 12.6% of cases, while with incomplete erosions of type II, they were found in 11.4%. The combination of complete erosions with erosive prepyloric changes (type IV) was identified in 8.7%. In the control group, gastric erosive lesions were mainly represented by type III (41%) and type IV (38.8%). Based on the analysis of endoscopic changes in the gastric mucosa using WLI, NBI, and ZOOM modes, the most characteristic visual changes were identified for each type and subtype of erosive gastric mucosa alterations. In patients with chronic heart failure II-III NYHA functional class, gastritis was noted in 75.1% of cases in the main group and in 58.5% in the control group. Helicobacter pylori infection of weak degree was determined in 40.5% in the main group and 37.7% in the control group. Evaluation of endoscopic pH-metry showed predominantly hypochlorhydria in both groups - 70.8% in the main group and 48.6% in the control group. Conclusion: By comparing the macroscopic features of various gastric erosive lesions in WLI, NBI, and ZOOM modes according to the classification by K. Toljamo (2012), the most characteristic signs for each type and subtype were identified. High prevalence of gastritis was established among patients with chronic heart failure II-III NYHA functional class.

Impact Of Exercise Delivery Mode Under The Covid-19 Pandemic: A Comparison Of Face-to-face Versus Zoom In Patients With Diabetes And/or Hypertension

Patients were commonly referred to a face-to-face center-based exercise program by healthcare providers. With the recent restriction on social gathering under the impact of Covid-19 pandemic, online exercise program delivered through videoconferencing system (e.g., Zoom) may be a promising solution to overcome this barrier. To date, little information is known about the relative effectiveness of exercise program delivered through face-to-face versus online modes. PURPOSE:To compare the effectiveness of exercise training delivery between the face-to-face and online (Zoom) mode. METHODS:A total of 59 patients (age: 65.7 ± 6.9 yrs-old) with diabetes and/or hypertension completed a 12-week exercise program (60 minutes/session, one session/week) delivered through either a face-to-face (n = 27) or videoconferencing system (Zoom) (n = 32). Health-related physical fitness including handgrip (muscular strength), 30-second chair stand test (lower body strength), chair sit-and-reach test (lower limb flexibility), and 2-minute step test (aerobic endurance) were measured at the baseline and post-intervention. RESULTS:Both groups demonstrated significant improvement in all health-related fitness parameters (p < .05) except the 30-second chair stand test on face-to-face group. Only the 30-second chair-stand test found significant interaction (p < .001). Score of 30-second chair stand test for online group improved from 13.8 ± 0.7 reps to 18.5 ± 0.8 reps (p < .001). CONCLUSIONS:Besides traditional face-to-face exercise delivery mode, online-exercise delivery mode may be an alternative option to improve similar health related outcomes among patients with diabetes and/or hypertension, especially under restriction of social interaction such as the Covid-19 pandemic.

Relationship between oxidative stress and three-dimensional echocardiographic changes in myxomatous mitral valves with severe regurgitation - a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background. Reactive oxygen species (ROS) have been reported to contribute to the molecular pathogenesis of severe mitral regurgitation induced by myxomatous degeneration. Data about oxidative stress and the possible relationship with the extent of prolapsing and/or flail elements is scarce in the literature. The pathogenic mechanism may prompt the development of therapeutic approaches aimed at delaying extensive valvular alteration. Purpose. The aim of the study is to investigate the possible correlation between ROS expression in myxomatous mitral valves with severe regurgitation and the extent of valvular alteration. Material and methods. Samples from myxomatous mitral valves with ruptured chordae and severe regurgitation were harvested during surgical intervention for valve repair/replacement from 9 patients. Besides transthoracic echocardiography, all patients were evaluated before surgery by transesophageal echocardiography (TEE) with three-dimensional (3D) reconstruction of the mitral valve, using 3D zoom mode acquisition with qualitative and quantitative analysis through the 4D Auto MVQ technology. Tissue from the valvular samples was further analysed for the assessment of ROS by 2 methods: spectrophotometry (ferrous oxidation xylenol orange - FOX assay) and confocal microscopy (dihydroethidium staining). Results. Patients had a mean age of 51.88 ± 13.54 years, with a left ventricular ejection fraction of 62.55 ± 7.33%, left ventricular end-diastolic diameter of 5.4 ± 0.72cm and end-diastolic volume of 168.55 ± 62.57ml, a mitral annulus area of 17.91 ± 5.74 cm2 and a number of prolapsing/flail scallops varying between 1 and 5 (average of 2 ± 1 scallops). All patients had diffuse thickening of the mitral leaflets with at least one primary and one secondary ruptured chordae and flail of the P2 scallop. Two patients had significant prolapse of at least 2 anterior mitral leaflet scallops and three patients had supplemental significant prolapse and/or flail of at least 1 posterior scallop, besides flail of P2. The mean value for ROS in the valvular tissue was 9.46 ± 2.03nM H2O2/mg tissue/h at FOX assay. A significant positive correlation between the ROS values and the extent of prolapsing/flail segments was found (R = 0.67, p = 0.04). Conclusion. Besides the diagnosis and accurate preoperatory valve description, 3D TEE along with molecular investigations contribute to the understanding of myxomatous mitral valves’ pathogenesis. Oxidative stress increased in the mitral valves with advanced myxomatous degeneration. Whether this occurs as a cause or a consequence contributing to the disease progression as well as the sources of ROS are worth further investigation.

Design and Development of an Automated Dual-Mode Microscopic System Using Electrically Tunable Lenses.

Maintaining telecentricity and zooming in microscopic systems with prolonged depths of focus is a difficult challenge because these properties degrade while moving to different axial planes in the extended focal depth. In this paper, we propose the proof of concept for an automated dual-mode microscopic system that combines two electrically tunable lenses (ETLs) with a variable numerical aperture controller placed. It acts as a viable solution to allow both multiplane microscopic zooming and telecentricity with consistent image resolution throughout the objective's extended focal depth. The image plane remains fixed for both the modes of operation, namely telecentricity and multiplane zooming. To validate the performance of the proposed idea, both simulations and experiments are carried out at various ETL curvature ranges. Over the whole zoom distance range, the experimental zoom ratio is determined to range from −2.723X to −34.42X. The experimental and simulation findings are compared and found to be quite similar, with magnification error percentages of 2.26% for zoom mode and 1.27% for telecentric mode. The comprehensive explanation of simulation and experimental results demonstrate the feasibility of the proposed method for both multiplane zoom and telecentric operations on a single platform in microscopic applications.

In-flight calibration results of the TROPOMI payload on board the Sentinel-5 Precursor satellite

Abstract. After the launch of the Sentinel-5 Precursor satellite on 13 October 2017, its single payload, the TROPOspheric Monitoring Instrument (TROPOMI), was commissioned for 6 months. In this time the instrument was tested and calibrated extensively. During this phase the geolocation calibration was validated using a dedicated measurement zoom mode. With the help of spacecraft manoeuvres the solar angle dependence of the irradiance radiometry was calibrated for both internal diffusers. This improved the results that were obtained on the ground significantly. Furthermore the orbital and long-term stability was tested for electronic gains, offsets, non-linearity, the dark current and the output of the internal light sources. The CCD output gain of the UV, UVIS and NIR detectors shows drifts over time which can be corrected in the Level 1b (L1b) processor. In-flight measurements also revealed inconsistencies in the radiometric calibration and degradation of the UV spectrometer. Degradation was also detected for the internal solar diffusers. Since the start of the nominal operations (E2) phase in orbit 2818 on 30 April 2018, regularly scheduled calibration measurements on the eclipse side of the orbit are used for monitoring and updates to calibration key data. This article reports on the main results of the commissioning phase, the in-flight calibration and the instrument's stability since launch. Insights from commissioning and in-flight monitoring have led to updates to the L1b processor and its calibration key data. The updated processor is planned to be used for nominal processing from late 2020 on.

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.

HOW CHILDREN PERCEIVE FOOD ADVERTISEMENTS ON TV: A SEMIOTICS ANALYSIS

In digital era, advertising can reach people wider than before. Children are one of targeted consumers for food advertisements. Everyday children are shown by food advertisements while they are watching TV. These advertisements functioned both to deliver and utilize a wide variety of meaning, symbols and message called semiotics. Moreover, children are treated with variety of signs and symbols, but they have different ways of interpreting them.. This study investigated ten children (8-to-10 years old) to know about their perception towards food advertisements. Using semiotics analysis researcher interviewed children about ten food advertisements that are broadcasted on TV. The result shows that most of children can perceive well all signs and symbols communication conveyed by food advertisement. The most influence symbol that affected children to try product is food image that are usually performed in zoom mode and slow motion. Children also get understanding message, culture and value conveyed by food advertisements in positive side. It can support children to behave positively. While brand personal get les attention that brand character of food advertisements which children prefer more cartoon character as a brand mascot of food product.

Left atrial thrombus in patients with atrial fibrillation and under oral anticoagulant therapy; 3-D transesophageal echocardiographic study.

Ischemic stroke is the major complication of atrial fibrillation (AF) and only proven preventive therapy is oral anticoagulant therapy (OAC). Previous studies reported the presence of thrombus in the left atrium (LA) or left atrial appendage (LAA) despite anticoagulant therapy. We aim to investigate the predictors of LA/LAA thrombus in patients under OAC therapy and long-term clinical impact of thrombus. We prospectively enrolled consecutive patients with permanent AF under OAC therapy. Patients baseline characteristics were recorded. Transesophageal echocardiographic study performed after complete transthoracic echocardiographic study. 3-D evaluation of LAA was made using 3-D zoom mode and thrombus was defined when echo reflecting, mobile mass detected. Patients clinical outcomes were decided according to hospital records or via phone calls. Among 184 patients, 28 LAT were detected. Mean CHA2DS2-VASc score was significantly higher in patients with LAT in comparison to patients without LAT. CHA2DS2-VASc score (p: 0.001), left atrial volume (p: 0.001), left atrial flow velocity (p: 0.006) and left ventricular ejection fraction (p: 0.014) were independently associated with LAT. Among the parameters in CHA2DS2-VASc score, the previous history of stroke and age were independently related to LAT. After 12months of follow-up, patients with LAT had more ischemic stroke than patients without LAT (7.1% vs 4.4%, p: 0.001 respectively). Although oral anticoagulation is the default treatment strategy for prevention of LAT and thromboembolism in patients with non-valvular AF, LAT still can be detected especially in patients with a high CHA2DS2-VASc score. Furthermore, the presence of LAT is significantly associated with future ischemic stroke.

Detection Accuracy of Bone Defects Depending on Exposure Settings of Cone Beam Computed Tomography.

Despite the widespread use of cone beam computed tomography (CBCT), few articles have been published to assess the accuracy in detecting alveolar bone defects using different CBCT exposure settings. A human cadaver with rounded bone defects in various locations was scanned using a CBCT scanner at different settings. Four examiners twice studied 1,500 cross-sectional digital and printed slices for defect presence, location, and size. High-resolution zoom mode achieved the highest overall accuracy. Moreover, apical location of the defects significantly affected overall accuracy. Bone defect detection depends upon exposure settings of CBCT scans. Exposure settings and field of view dimensions should be individualized per case.

P1714 When the mechanism of mitral regurgitation is unclear, 3D Trans-esophageal echocardiography is the solution

Abstract Introduction Assessment of mitral regurgitation (MR) mechanism is not always easy and may require advanced imaging techniques. A 28-year-old male presented with significant MR three years following surgical mitral valve repair for severe MR due to mitral valve prolapse. During surgery, he underwent artificial chordal implantation on A2 scallop and Gore-Tex posterior band annuloplasty. Early post-operative transthoracic echocardiography (TTE) showed mild to moderate eccentric, posteriorly directed MR of unknown mechanism. Since the patient was asymptomatic, only regular follow-up was advised. He missed his follow-up for three years after which presented complaining of exertional dyspnea NYHA class II. TTE showed dilated left ventricular dimensions with moderate to severe MR of unknown mechanism. 2D trans-esophageal echocardiography (TEE) (figure 1, panel A&amp; B) showed severe, posteriorly directed mitral regurgitation, with a mass (arrow head) at the level of the mitral annulus. 3D TEE (figure 1,panel C, 3D zoom mode and panel D, true view mode) showed dehiscence (arrow head) of the annuloplasty band from the posterior mitral annulus with a wide gap measuring 83 mm² in 3D planimetred area. The patient was referred for re-do surgery. Conclusion 3D TEE has a great added value in elucidating the mechanism of MR in obscure cases and guiding the proper management strategy. Abstract P1714 Figure 1

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

High-Definition Zoom Mode: A High Resolution X-ray Microscope for Neurointerventional Treatment Procedures.

Visualization of structural details of treatment devices during neurointerventional procedures can be challenging. A new true two-resolution imaging X-ray detector system features a 194µm pixel conventional flat-panel detector (FPD) mode and a 76µm pixel high-resolution high-definition (Hi-Def) zoom mode in one detector panel. The Hi-Def zoom mode was developed for use in interventional procedures requiring superior image quality over a small field of view (FOV). We report successful use of this imaging system during intracranial aneurysm treatment in 1 patient with a Pipeline-embolization device and 1 patient with a low-profile visualized intramural support (LVIS Blue) device plus adjunctive coiling. A guide catheter was advanced from the femoral artery insertion site to the proximity of each lesion using standard FPD mode. Under magnified small FOV Hi-Def imaging mode, an intermediate catheter and microcatheters were guided to the treatment site, and the PED and LVIS Blue plus coils were deployed. Radiation doses were tracked intraprocedurally. Critical details, including structural changes in the PED and LVIS Blue and position and movement of the microcatheter tip within the coil mass, were more readily apparent in Hi-Def mode. Skin-dose mapping indicated that Hi-Def mode limited radiation exposure to the smaller FOV of the treatment area. Visualization of device structures was much improved in the high-resolution Hi-Def mode, leading to easier, more controlled deployment of stents and coils than conventional FPD mode.

Transesophageal Echocardiography Examination in Ailuropoda melanoleuca.

Cardiac function analysis for Ailuropoda melanoleuca, also called giant panda, with transthoracic echocardiography has several limitations, such as limited probe position area and poor echo window. We want to determine the feasibility of transesophageal echocardiography (TEE) for cardiac examination in Ailuropoda melanoleuca. Eight-year-old male Ailuropoda melanoleuca was anesthetized by intramuscular ketamine and followed by inhalation isofl urane with spontaneous respiration. TEE probe was inserted through mouth. Comprehensive examinations were done by two-dimensional (2D), Doppler method, 3D zoom and 3D full volume mode for their cardiac evaluation. The structure of heart was similar to human. We found mild mitral regurgitation. Right ventricle and pulmonary artery were free of any organic lesions. We did comprehensive multiplane examination by American Society of Echocardiography/Society of Cardiovascular Anesthesia guideline, but transgastric (TG) and deep TG view were not approachable. 3D reconstruction offered high quality image and quantitative calculations. Complete examinations took less than 30 minutes. There was no significant hemodynamic change during probe insertion, and no oropharyngeal trauma certifi ed by dentist. TEE is a reasonable semi-invasive tool for cardiac function evaluation. Though some anatomical limitations prohibited comprehensive 2D views, improvements such as 3D images help to give detailed cardiac examination.

Strategies for radiation exposure-sparing in fluoroscopically guided invasive cardiovascular procedures.

Minimizing radiation exposure during x-ray fluoroscopically guided procedures is critical to patients and to medical personnel. Tableside adjustment of x-ray image acquisition parameters can vary the fluoroscopic radiation exposure rate. To determine the impact of adjusting four tableside controllable image acquisition parameters on x-ray fluoroscopic radiation exposure rate. We made fluoroscopic exposures of a standard radiologic phantom to measure radiation exposure rates as kerma•area product per second of exposure and milligray per x-ray pulse under all possible combinations of detector zoom mode, collimated image field size, fluoroscopy dose mode, and fluoroscopy pulse frequency. Kerma•area product per second was linearly proportional to pulse frequency. Selecting larger detector zoom modes, smaller collimated image field sizes and low dose fluoroscopy mode each decreased exposure rate. We found a > 20-fold variation in dose rates over the range of acquisition parameter combinations. Selecting the most appropriate fluoroscopy acquisition parameters enables physician operators to adjust radiation exposure rates over a large range. Judicious selection of acquisition parameters can reduce patient and medical personnel radiation exposure by as much as 95% compared to "standard" fluoroscopy protocol settings.

ПІДХІД ДО ВИБОРУ ПРОГРАМНО-ТЕХНІЧНОЇ ТА ОБҐРУНТУВАННЯ ТЕХНОЛОГІЧНОЇ ОСНОВИ СТВОРЕННЯ ІНТЕРАКТИВНОЇ КАРТИ ПРИРОДНО-ЗАПОВІДНОГО ФОНДУ УКРАЇНИ В ПОЛТАВСЬКІЙ ОБЛАСТІ

Author’s approach to the choice of software and technological basis for compilation a thematic interactive map of the Natural Reserve Fund of Ukraine (NRFU) in Poltava region was offered in the article. The content of relevant key concepts and tendencies of their progressive development under the conditions of scientific-and-technological advance were revealed. On the basis of working in a full-featured and multifunctional geoinformation systems (GIS) environment practical experience, the criteria for the selection of application software products suitable for the thematic interactive maps compilation, taking into account the peculiarities of information and software of the created database of NRFU objects were determined. They were: free distribution; freedom of manipulation with functionality; dynamic development; extended documentation support; interoperability. It was selected full-featured GIS – QGIS, the most optimal GIS that was installed on the technical system or that would be used to obtain a thematic interactive map of the NRF in Poltava region. For the most part, it was characterized the content of the corresponding cartographic working out, which consists of more than 200 objects, divided into 4 main categories of national and local importance (national nature park; nature reserve of national importance; natural monuments, botanical gardens and parks of national importance; territories and local nature reserve fund objects) that were displayed with the dot, line, and plane symbols in a certain electronic map-full zoom mode. The main principles of forming of the technical and technological component in the algorithm of compilation the modern types of cartographic works were determined and adapted to the interactive specified region NRF map development. There was constructed a structural and graphical model, which represented the system settings of the most active elements of the process, determining the technological way to obtain the eventual result (a product in the form of a cartographic product or service), and was carried out with the help of the necessary tools, organized into a corresponding technological scheme.

Analysis of the Relationships according to the Frame (f/s) Change of Cine Imaging in Coronary Angiographic System: With Focus on FOV Enlargement and Live Zoom

This study aimed to investigate the difference of X-ray exposure by comparing and analyzing absorbed dose according to changes in the number of frames in coronary angiography, also depending whether the zoom mode is FOV enlargement or Zoom Live. Moreover, for appropriate frame selection measures for examination, including the effect of frame change on the image quality, were sought by measuring the noise strength expressed by the standard deviation (SD), the signal to noise ratio (SNR) and contrast to noise ratio (CNR). The study was conducted with an anthropomorphic phantom on an angio-system. The linear relationship between the frame rate and the radiation dose was evident. On the contrary, the indices of image quality (SD, SNR, and CNR) were almost constant irrespective of the number of frames. The difference depending on the zoom mode was not statistically significant for DAP, air kerma, and SD (p > 0.05). However, SNR and CNR were statistically different between FOV enlargement and Zoom Live. In conclusion, since the image quality was not degraded significantly with the decreasing frame rate from 30, 15, to 7.5 f/s and the radiation dose evidently decreases in almost exactly linear proportion to the decreasing frame rate, the number of frames per second needs to be maintained as low as reasonably achievable. As for the dependence on the zooming mode, the Live Zoom mode showed statistically significant improvement in the image quality indices of SNR and CNR and it justifies active use of the Live Zoom mode which enables real-time image enlargment without additional radiation dose.

Optimal surface property for three-dimensional echo visualization.

Three-dimensional (3D) echo is a useful modality to guide off-pump intracardiac surgery, and this study aimed to determine the optimal surface property for minimizing echo dropout and grating lobes. A total of 13 specimens were examined. The specimens were scanned while they were rotated from 0° to 90°, and en face views were recorded in the 3D zoom mode. Changes in brightness were compared with the surface profile, which was traced from microscopic images. The brightness and size of grating lobes were also examined. Decreases in brightness that were observed at a large rotation angle were classified into three groups (sharp, moderate, and gradual), and variation in the effective reflective plane size appeared to be a major determinant of this property. The same material showed different degrees of reflection depending on the surface profile. The size of grating lobes was affected by variation in the reflective plane size, but not by the intensity of reflection. The brightness of the grating lobes was similar among specimens. These results suggest that echo dropout and grating lobes can be effectively eliminated by an appropriate surface profile; thus, a likely practical solution would be to manufacture a surface that provides an adequate reflective surface size at various incident angles.

Tips and Tricks of Transesophageal Echocardiographic Guidance During Cardiac Interventions

Online transesophageal echocardiographic (TEE) guidance has become a useful and convenient technique for various structural heart disease interventions, e.g., interatrial septal puncture, balloon mitral commissurotomy, mitraClipping, atrial septal defect (ASD) device closure etc. There are some important tips and tricks. (1). For septal puncture, 2D echo may be better than 3-D echo. The optimal tenting sign should be managed to appear on the bicaval plane before protruding the puncture needle. If the tenting sign appears on a plane showing the right upper pulmonary vein, it indicates that the needle is pointing too posteriorly, increasing the risk of atrial wall perforation. Conversely, if the tenting sign appears on a plane showing the ascending aorta, it indicates that the needle is pointing too anteriorly, increasing the risk of aortic perforation. (2). Live 3D zoom mode is very convenient and better than 2D for monitoring ASD device deployment. (3). Fluoroscopy is still useful for monitoring some parts of the intervention procedures. If available, fusion imaging would be very convenient. (4). The duration of using color Doppler and 3-D echo should be kept short. Long duration tends to elevate the temperature of the TEE probe. (5). When using loop function, the time mode may be more desirable than the beat mode to prevent interruption of an important recording.

3D transthoracic echocardiography to assess pulmonary valve morphology and annulus size in patients with Tetralogy of Fallot

Accurate evaluation of the pulmonary valve (PV) is crucial before surgical repair of Tetralogy of Fallot (TOF). To assess PV and pulmonary annulus (PA) morphology using three-dimensional (3D) transthoracic echocardiography (TTE) in infants referred for surgical repair of TOF. Also, to compare PA measurements obtained by 3D TTE with those from other imaging modalities, including two-dimensional (2D) TTE and computed tomography (CT), with reference to surgical measurements. 3D zoom mode was used to assess PV morphology. 2D TTE and CT PA diameters were compared to both vertical and horizontal diameters obtained from 3D datasets. Surgical PA diameters were measured using Hegar's dilators. A total of 29 patients with TOF (median [range] age 6 [3-24] months) were included and all successfully underwent 2D and 3D TTE; 22 also underwent CT. The number of pulmonary leaflets could be visualized in 24 patients (82.8%), with complete concordance with surgical findings. Vertical diameter was significantly longer than horizontal diameter (P<0.001)-underlying PA eccentricity-and was more important in bicuspid than tricuspid valves. Correlations between 2D and 3D TTE diameters were good. Surgical diameter was better correlated with 2D and 3D diameters than with CT diameter. 3D minimum, 2D and CT diameters were significantly lower than surgical diameters, but 3D mean and maximum diameters were not. 3D TTE is accurate to assess PV morphology and PA size in patients with TOF. 2D TTE and CT underestimate PA diameter with reference to surgical diameter, however 3D mean and maximum diameters did not differ significantly.

0443: 3D transthoracic echocardiography assessment of the pulmonary valve in patients with TOF

Accurate evaluation of pulmonary valve (PV) morphology and pulmonary annulus (PA) diameter is crucial before surgical correction of tetralogy of Fallot (TOF). Our aim was to assess PV morphology using three-dimensional transthoracic echocardiography (3D-TTE) in infants with TOF before surgical correction. And to compare PA diameter obtained by different imaging modalities. 30 patients with TOF were prospectively included. All patients underwent 2D and 3D-TTE, 23 patients underwent CT-Scan and 7 cardiac catheterization. PA diameter was measured using 2D-TTE in parasternal short axis view as recommended. 3D dataset was acquired using zoom mode at PV. Both vertical (Dv) and horizontal (Dh) diameters of PA were measured. Mean 3D diameter (3DD) was calculated as (Dv+Dh/2). Eccentricity index (EI) of PA was calculated (Dv—Dh/Dv). These measurements were compared to CT-Scan and angiography when available and to perioperative measurements. Mean age 7.4 months (3-24 months), mean weight 6.6kg (4.5-13.5kg). PV was described as bicuspid in 15/30 patients by 3D-TTE from en face view, with 75% agreement between 3D-TTE and perioperative finding (20/30 patients). PA geometry was slightly asymmetric by 3D-TTE. Dv was significantly larger than Dh (8.4mm vs 7.4mm, p=0.001), and mean EI of PA was (10%). PA was more asymmetric in bicuspid valves rather than in tricuspid valves (EI 14% vs 7%, p=0.002). PA diameter didn’t differ significantly between 2D-TTE, Dh, CT scan and angiography, and were significantly lower than mean 3DD and Dv. There was a very strong correlation between 3DD and perioperative measurement. PA was conserved in 53.3% without significant residual stenosis immediately and after a 20 month of follow-up (except 1 patient requiring balloon dilatation). 3D-TTE in patients with TOF is an accurate method to describe PV, and to measure PA size. Thus could help the surgical repair and the preservation of PV function.