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To acquire volume-rendered images of the left atrial appendage (LAA) chambers by three-dimensional transesophageal echocardiography (3DTEE) using a novel image mode called Gray Values Inverted Imaging (GVI). This mode of imaging can achieve similar effects to cardiac computed tomography angiography (CCTA) and can accurately assess the morphology of the LAA.
Three-dimensional transesophageal echocardiography (3DTEE) and CCTA were performed on 40 patients with atrial fibrillation prior to catheter ablation. Full-volume 3D data were acquired and displayed in gray values inverted (GVI) mode. Threshold segmentation and Interactive segmentation were used to create 3D digital replicas of LAA chambers. The LAA morphology classification, number of lobes and LAA dimensions were analyzed and compared with the data obtained by CCTA.
LAA morphology and measurements were successfully acquired by CCTA and 3DTEE-GVI in all 40 cases. In terms of the LAA morphology classification, 19 cases of chicken wing, 8 of windsock, 9 of cauliflower and 4 of cactus were determined by 3DTEE-GVI, and 20 cases of chicken wing, 8 of windsock, 8 of cauliflower and 4 of cactus were determined by CT-VR. The consistency between these two methods was 97.5%. The measurements of long axis, short axis, ostial area, and depth of the LAA by CT were larger using 3DTEE-GVI than CT-VR (p<0.01); however, agreements existed between them. Formed thrombosis was well displayed by both CT-VR and 3DTEE-GVI as well.
3DTEE-GVI can acquire LAA morphologic volume-rendered images that are similar to CT volume-rendered images, and it shows promise as a feasible and valuable modality for individual LAA occlusion planning.