HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Suematsu, Y. Articles by del Nido, P. J. Search for Related Content PubMed PubMed Citation Articles by Suematsu, Y. Articles by del Nido, P. J. Related Collections Coronary disease

J Thorac Cardiovasc Surg 2004;128:579-587
© 2004 The American Association for Thoracic Surgery

Three-dimensional echocardiography–guided beating-heart surgery without cardiopulmonary bypass: A feasibility study

^a Departments of Cardiac Surgery and Cardiology, Children's Hospital-Boston and Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA
^b Department of Aerospace and Mechanical Engineering, Boston University, Boston, Mass, USA
^c Division of Engineering and Applied Sciences, Harvard University, Cambridge, Mass, USA
^d Philips Medical Systems, Andover, Mass, USA

Received for publication April 13, 2004; revisions received May 21, 2004; accepted for publication June 1, 2004.

^* Address for reprints: Pedro J. del Nido, MD, Department of Cardiac Surgery, Children's Hospital-Boston, 300 Longwood Ave, Boston, MA 02115 (E-mail: pedro.delnido{at}tch.harvard.edu).

BACKGROUND: There is no current acceptable approach for intracardiac beating-heart interventions. We have adapted real-time 3-dimensional echocardiography with specialized instrumentation to facilitate beating-heart repair of atrial septal defects and mitral valve plasty to investigate the feasibility of real-time 3-dimensional echocardiography–guided cardiac surgery.

METHODS: In experiment I a modified real-time 3-dimensional echocardiography system with x4 matrix transducer was compared with 2-dimensional echocardiography in the performance of common surgical tasks. Completion times, deviation from an ideal trajectory, and an echogenic target were measured. In experiment II porcine atrial septal defects were closed with an original semiautomatic suturing device (n = 4) and with a 5-mm endoscopic stapler and a pericardial or polytetrafluoroethylene patch (n = 4). In experiment III a pulsatile porcine mitral valve model was developed, and suture placement through the anterior and posterior mitral leaflets was performed (n = 8). During all experiments, the operator was blinded to the target and operated on only with ultrasonic guidance.

RESULTS: In experiment I, compared with 2-dimensional echocardiographic guidance, completion times improved by 21% (P < .01) with high-trajectory accuracy, and suture deviation was significantly smaller (2-dimensional echocardiography, 5.4 ± 2.7 mm; 3-dimensional echocardiography, 1.7 ± 0.7 mm; P < .05) in real-time 3-dimensional echocardiography–guided tasks. In experiments II and III in both atrial septal defect closure and mitral valve plasty, real-time 3-dimensional echocardiography provided satisfactory images and sufficient anatomic detail for suturing and patch deployment. All surgical tasks were successfully performed with accuracy.

CONCLUSIONS: Real-time 3-dimensional echocardiography provides adequate imaging and anatomic detail to act as a sole guide for surgical task performance. These initial experiments demonstrate the feasibility of beating-heart direct or patch closure of atrial septal defects and mitral valve plasty without cardiopulmonary bypass.

This article has been cited by other articles:

				Y. Suematsu, B. Kiaii, D. T. Bainbridge, P. J. del Nido, and R. J. Novick Robotic-assisted closure of atrial septal defect under real-time three-dimensional echo guide: in vitro study Eur. J. Cardiothorac. Surg., October 1, 2007; 32(4): 573 - 576. [Abstract] [Full Text] [PDF]

				J. Huang, J. K. Triedman, N. V. Vasilyev, Y. Suematsu, R. O. Cleveland, and P. E. Dupont Imaging Artifacts of Medical Instruments in Ultrasound-Guided Interventions J. Ultrasound Med., October 1, 2007; 26(10): 1303 - 1322. [Abstract] [Full Text] [PDF]

				M. Handke, G. Heinrichs, U. Moser, F. Hirt, F. Margadant, F. Gattiker, C. Bode, and A. Geibel Transesophageal Real-Time Three-Dimensional Echocardiography: Methods and Initial In Vitro and Human In Vivo Studies J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2070 - 2076. [Abstract] [Full Text] [PDF]

				R. M. Lang, V. Mor-Avi, L. Sugeng, P. S. Nieman, and D. J. Sahn Three-Dimensional Echocardiography: The Benefits of the Additional Dimension J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2053 - 2069. [Abstract] [Full Text] [PDF]

				Y. Suematsu, B. N. Mora, T. Mihaljevic, and P. J. del Nido Totally Endoscopic Robotic-Assisted Repair of Patent Ductus Arteriosus and Vascular Ring in Children Ann. Thorac. Surg., December 1, 2005; 80(6): 2309 - 2313. [Abstract] [Full Text] [PDF]

				Y. Suematsu, J. F. Martinez, B. K. Wolf, G. R. Marx, J. A. Stoll, P. E. DuPont, R. D. Howe, J. K. Triedman, and P. J. del Nido Three-dimensional echo-guided beating heart surgery without cardiopulmonary bypass: Atrial septal defect closure in a swine model J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1348 - 1357. [Abstract] [Full Text] [PDF]