Cannulation of the aortic branches using ultrasound guidance. An animal study.

Catheter placement by ultrasound may reduce radiation, improve positioning, and allow the use of echo contrast agents for diagnostic and therapeutic procedures. To evaluate its utility in the peripheral and coronary vascular beds, a preshaped 20 MHz Doppler catheter was inserted into the femoral artery for renal artery, or into the right carotid artery for left coronary artery cannulation in five dogs. Ultrasonic imaging of the vascular structure and catheter was provided by either transabdominal or transesophageal ultrasound. Using Doppler waveform polarity for retrograde guidance, the catheter was advanced to the region of the left renal or left coronary ostia. Ultrasonic emissions from the Doppler catheter were identified by color Doppler mode of the ultrasound machine and allowed the catheter tip to be identified within the beam width of the scanning transducer, providing the depth dimension. In the two animals in which left renal artery cannulation was attempted, the catheter was successfully manipulated into the ostium. In two of the three animals in which left coronary artery cannulation was attempted, the catheter was successfully manipulated into the ostium, followed by saline contrast injections revealing myocardial perfusion. In addition, in one animal, a Doppler flow wire was identified as it was advanced into the mid circumflex coronary. In conclusion, ultrasonically guided cannulation of aortic branches may be possible without x-ray, and this technique may lead to further use of ultrasound in diagnostic and therapeutic procedures.

The effect of vascular curvature on three-dimensional reconstruction of intravascular ultrasound images.

OBJECTIVE: To characterize the effect of vessel curvature on the geometric accuracy of conventional three-dimensional reconstruction (3DR) algorithms for intravascular ultrasound image data. BACKGROUND: A common method of 3DR for intravascular ultrasound image data involves geometric reassembly and volumetric interpolation of a spatially related sequence of tomographic cross sections generated by an ultrasound catheter withdrawn at a constant rate through a vascular segment of interest. The resulting 3DR is displayed as a straight segment, with inherent vascular curvature neglected. Most vascular structures, however, are not straight but curved to some degree. For this reason, vascular curvature may influence the accuracy of computer-generated 3DR. METHODS: We collected image data using three different intravascular ultrasound catheters (2.9 Fr, 4.3 Fr, 8.0 Fr) during a constant-rate pullback of 1 mm/sec through tubing of known diameter with imposed radii of curvature ranging from 2 to 10 cm. Image data were also collected from straight tubing. Image data were digitized at 1.0-mm intervals through a length of 25 mm. Two passes through each radius of curvature were performed with each intravascular ultrasound catheter. 3DR lumen volume for each radius of curvature was compared to that theoretically expected from a straight cylindrical segment. Differences between 3DR lumen volume of theoretical versus curved (actual) tubes were quantified as absolute percentage error and categorized as a function of curvature. Tubing deformation error was quantified by quantitative coronary angiography (QCA). RESULTS: Volumetric errors ranged from 1% to 35%, with an inverse relationship demonstrated between 3DR lumen volume and segmental radius of curvature. Higher curvatures (r < 6.0 cm) induced greater lumen volume error when compared to lower curvatures (r > 6.0 cm). This trend was exhibited for all three catheters and was shown to be independent of tubing deformation artifacts. QCA-determined percentage diameter stenosis indicated no deformation error as a function of curvature. Total volumetric error contributed by tubing deformation was estimated to be 0.05%. CONCLUSIONS: Catheter-dependent geometrical error arises in three-dimensionally reconstructed timed linear pullbacks of intravascular ultrasound images due in part to uniplanar vascular curvature. Three-dimensional reconstruction of timed linear pullbacks is robust for vessels with low radii of curvature; however, careful interpretation of three-dimensional reconstructions from timed linear pullbacks for higher radii of curvature is warranted. These data suggest that methods of spatially correct three-dimensional reconstruction of intravascular ultrasound images should be considered when more pronounced vascular curvature is present.

Utility of transesophageal echocardiography in the diagnosis of disease of the thoracic aorta.

PURPOSE: Transesophageal echocardiography (TEE) offers a rapid, minimally invasive method for diagnosing thoracic aortic disease. High-resolution images are possible because of the close proximity of the esophagus and vascular structures within the chest. Lung and chest wall components have little influence on the image quality and a virtually unobstructed view of the heart, thoracic aorta, and pulmonary vasculature is seen. The role of TEE in diagnosing diseases of the thoracic aorta is rapidly developing. The purpose of this study is to define the role of TEE in the diagnosis of thoracic aortic disease. METHODS: Between July 1, 1989 and December 31, 1992, 1005 TEEs were performed at our center. Of these, 199 (125 men, 74 women) were entered into our aortic disease registry. Indications for the studies included 37 referrals to rule out aortic dissection, 18 to assess aortic aneurysm, 55 to assess for an intraaortic source of embolus, 9 to rule out intraaortic thrombus, and 13 with familial hyperlipidemia being followed to mark response to low-density lipoprotein apheresis. In 67 cases, subclinical aortic plaquing was found incidentally. No complications from the TEE procedure were encountered. RESULTS: In cases of suspected aortic dissection, TEE was equal to computed tomography (CT) scanning in identifying the type (DeBakey) and extent of thoracic aortic dissection. In addition, TEE provided information regarding functional status of the aortic valve, identified interluminal communications, and assessed blood flow and thrombus burden in the false lumen. TEE correctly identified true aneurysms, intraluminal thrombus, and plaques as possible sources of emboli. One false-positive CT scan result for aortic dissection was seen and was ruled out both by TEE and angiography. CONCLUSION: Biplane TEE can be considered the method of choice in diagnosing disease of the thoracic aorta. Information from TEE can be obtained at the patient's bedside or in the operating suite, to assess surgical results before procedure termination and afterward for follow-up. Adjunctive magnetic resonance imaging, CT scanning, or aortography may be needed to assess extension of the disease process into the abdomen or pelvis or to plan surgical intervention.

Pseudophakic bullous keratopathy with Intermedics model 024 (Hessburg) anterior chamber intraocular lenses.

We report the development of pseudophakic bullous keratopathy in 18 eyes following implantation of Pharmacia Intermedics Ophthalmics model 024 (Hessburg) anterior chamber intraocular lenses. Eight of these intraocular lenses were implanted during uncomplicated intracapsular cataract extractions. Mean onset of corneal edema was 21.4 months after lens implantation. Patients with this type of lens already implanted in their eyes require close follow-up for complications.