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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
2012 Impact Factor: 1.746
2012 SCImago Journal Rankings: 0.966
 
DOIhttp://dx.doi.org/10.1111/j.1540-8159.2006.00384.x
 
ReferencesReferences in Scopus
 
DC FieldValue
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
2012 Impact Factor: 1.746
2012 SCImago Journal Rankings: 0.966
 
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
 
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<contributor.author>Ooi, CGC</contributor.author>
<contributor.author>Siu, CW</contributor.author>
<contributor.author>Yiu, MWC</contributor.author>
<contributor.author>Pang, C</contributor.author>
<contributor.author>Lau, CP</contributor.author>
<contributor.author>Tse, HF</contributor.author>
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<description.abstract>Background: 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) &quot;Navigator&quot; reconstruction technique. Methods: Forty-five consecutive patients (37 men, mean age 52.7 &#177; 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 &quot;Navigator&quot; 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 &#177; 5.8 mm (range 10.5-35.3 mm) and 41.9 &#177; 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. &#169;2006, Blackwell Publishing, Inc.</description.abstract>
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Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong