Article: Endocardial visualization of esophageal-left atrial anatomic relationship by three-dimensional multidetector computed tomography "navigator imaging"

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TitleEndocardial visualization of esophageal-left atrial anatomic relationship by three-dimensional multidetector computed tomography "navigator imaging"
AuthorsWang, SL1
Ooi, CGC1
Siu, CW1
Yiu, MWC2
Pang, C2
Lau, CP1
Tse, HF1 2
Issue Date2006
PublisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1
CitationPace - Pacing And Clinical Electrophysiology, 2006, v. 29 n. 5, p. 502-508 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1540-8159.2006.00384.x
AbstractBackground: The close proximity of left atrium (LA) and esophagus during radiofrequency ablation for atrial fibrillation (AF) predisposes to thermal injury resulting in atrio-esophageal fistula. This work proposes to study the anatomic relationship between the esophagus and the LA wall using multidetector computed tomography (MDCT) three-dimensional (3D) "Navigator" reconstruction technique. Methods: Forty-five consecutive patients (37 men, mean age 52.7 ± 14.1 years) with preradiofrequency ablation MDCT scans of the thorax for AF were recruited. Length and type (continuous or interrupted) of fat pad between esophagus and LA were evaluated. The position, width, and length of the esophagus in contact (without fat pad) with the LA were determined by using "Navigator" software on the endocardial view of LA. Results: The fat pad was continuous in 4% (2 of 45) and interrupted in 96% (43 of 45) patients. The mean width and length of esophageal-LA contact in 43 cases with interrupted fat pad was 24.0 ± 5.8 mm (range 10.5-35.3 mm) and 41.9 ± 11.6 mm (5.4-64 mm), respectively. There was an inverse relationship between the lengths of the esophageal-LA contact and the upper fat pad (r = -0.50, P = 0.001). The esophagus was located to the left, right, and midline of the LA in 40, 2, and 1 patients, respectively, and the esophagus was in contact with and overrode the PV orifice in 22 and 4 patients, respectively. Conclusion: Direct esophageal-LA contact without the intervening fat pad was present in 96% of the cases, with 93% of esophagi lying to the left of the LA and 51% in contact with a PV orifice. Three-dimensional Navigator imaging technique has enhanced the visualization of the anatomical information of the esophagus, LA wall, and PV orifices that may be used to avoid thermal injury to the esophagus during LA ablation procedure. ©2006, Blackwell Publishing, Inc.
ISSN0147-8389
2011 Impact Factor: 1.351
2011 SCImago Journal Rankings: 0.157
DOIhttp://dx.doi.org/10.1111/j.1540-8159.2006.00384.x
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorWang, SL
dc.contributor.authorOoi, CGC
dc.contributor.authorSiu, CW
dc.contributor.authorYiu, MWC
dc.contributor.authorPang, C
dc.contributor.authorLau, CP
dc.contributor.authorTse, HF
dc.date.accessioned2012-09-05T05:26:05Z
dc.date.available2012-09-05T05:26:05Z
dc.date.issued2006
dc.description.abstractBackground: The close proximity of left atrium (LA) and esophagus during radiofrequency ablation for atrial fibrillation (AF) predisposes to thermal injury resulting in atrio-esophageal fistula. This work proposes to study the anatomic relationship between the esophagus and the LA wall using multidetector computed tomography (MDCT) three-dimensional (3D) "Navigator" reconstruction technique. Methods: Forty-five consecutive patients (37 men, mean age 52.7 ± 14.1 years) with preradiofrequency ablation MDCT scans of the thorax for AF were recruited. Length and type (continuous or interrupted) of fat pad between esophagus and LA were evaluated. The position, width, and length of the esophagus in contact (without fat pad) with the LA were determined by using "Navigator" software on the endocardial view of LA. Results: The fat pad was continuous in 4% (2 of 45) and interrupted in 96% (43 of 45) patients. The mean width and length of esophageal-LA contact in 43 cases with interrupted fat pad was 24.0 ± 5.8 mm (range 10.5-35.3 mm) and 41.9 ± 11.6 mm (5.4-64 mm), respectively. There was an inverse relationship between the lengths of the esophageal-LA contact and the upper fat pad (r = -0.50, P = 0.001). The esophagus was located to the left, right, and midline of the LA in 40, 2, and 1 patients, respectively, and the esophagus was in contact with and overrode the PV orifice in 22 and 4 patients, respectively. Conclusion: Direct esophageal-LA contact without the intervening fat pad was present in 96% of the cases, with 93% of esophagi lying to the left of the LA and 51% in contact with a PV orifice. Three-dimensional Navigator imaging technique has enhanced the visualization of the anatomical information of the esophagus, LA wall, and PV orifices that may be used to avoid thermal injury to the esophagus during LA ablation procedure. ©2006, Blackwell Publishing, Inc.
dc.description.natureLink_to_subscribed_fulltext
dc.identifier.citationPace - Pacing And Clinical Electrophysiology, 2006, v. 29 n. 5, p. 502-508 [How to Cite?]
DOI: http://dx.doi.org/10.1111/j.1540-8159.2006.00384.x
dc.identifier.citeulike616652
dc.identifier.doihttp://dx.doi.org/10.1111/j.1540-8159.2006.00384.x
dc.identifier.epage508
dc.identifier.issn0147-8389
2011 Impact Factor: 1.351
2011 SCImago Journal Rankings: 0.157
dc.identifier.issue5
dc.identifier.pmid16689846
dc.identifier.scopuseid_2-s2.0-33646516580
dc.identifier.spage502
dc.identifier.urihttp://hdl.handle.net/10722/162975
dc.identifier.volume29
dc.languageeng
dc.publisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1
dc.publisher.placeUnited States
dc.relation.ispartofPACE - Pacing and Clinical Electrophysiology
dc.relation.referencesReferences in Scopus
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshEndocardium - Anatomy & Histology - Radiography
dc.subject.meshEsophagus - Anatomy & Histology - Radiography
dc.subject.meshFemale
dc.subject.meshHeart Atria - Anatomy & Histology - Radiography
dc.subject.meshHumans
dc.subject.meshImaging, Three-Dimensional - Methods
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshSurgery, Computer-Assisted - Methods
dc.subject.meshTomography, X-Ray Computed - Instrumentation - Methods
dc.subject.meshTransducers
dc.subject.meshUser-Computer Interface
dc.titleEndocardial visualization of esophageal-left atrial anatomic relationship by three-dimensional multidetector computed tomography "navigator imaging"
dc.typeArticle
Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong