How to visualize and reconstruct the pulmonary valve and contiguous
structures with intracardiac echocardiography: a simplified multi-step
approach.
Abstract
Ventricular tachycardia and premature ventricular complexes (PVCs)
arising from right ventricular outflow tract (RVOT) are the most common
type of ventricular arrhythmias (VAs) in patients without structural
heart disease. Radiofrequency ablation is now the gold standard of
treatment in this setting due to high efficacy rates and optimal safety
profile [2] During the last few years, the pulmonary valve (PV) and
the pulmonary artery (PA) have attracted much attention as reliable
sites of origin of RVOT-type arrhythmias. In the mean while intracardiac
echocardiogram (ICE) has undoubtedly improved our understanding and
approach to manage these arrhythmias accurately characterizing the PV
and its contiguous structures. Aim of this paper is to provide an
illustrated step-by-step guide on how to use ICE with the CARTOSOUND
module to visualize and reconstruct 3D shell of the RV, the PV, as well
of other anatomical structures (i.e., the aortic valve and coronary
arteries) to perform aware and safe ablation in this region. A new
reconsideration of the existent classification of these VAs is also
provided.