Recent Advances in Percutaneous Cardioscopy

Current Cardiovascular Imaging Reports, Aug 2011

Percutaneous cardioscopy, using high-resolution fiberoptic imaging, enables direct visualization of the cardiac interior, thereby enabling macroscopic pathological diagnosis. Percutaneous cardioscopy has demonstrated that the endocardial surface exhibits various colors characteristic of different heart diseases. This imaging modality can now be used for evaluation of the severity of myocardial ischemia, and staging of myocarditis. Myocardial blood flow recovery induced by vasodilating agents or percutaneous coronary interventions can be clearly visualized. Morphological and functional changes in the cardiac valves can also be evaluated. Cardioscope-guided endomyocardial biopsy enables pin-point biopsy of the diseased myocardium. Recently, dye-image cardioscopy and fluorescence cardioscopy were developed for evaluation of the subendocardial microcirculation. Cardioscope-guided intracardiac therapies such as myotomy, myectomy, valvulotomy, and transendocardial angiogenic and myogenic therapy have been trialed using animal models in anticipation of future clinical applications. Percutaneous cardioscopy has the potential to contribute to our understanding of heart disease, and to assist in guidance for intracardiac therapies.

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Recent Advances in Percutaneous Cardioscopy

Yasumi Uchida 0 0 Developmental History of Percutaneous Cardioscopy 1 ) Japan Foundation for Cardiovascular Research , 2-30-17, Narashinodai, Funabashi 274-0063, Japan Percutaneous cardioscopy, using high-resolution fiberoptic imaging, enables direct visualization of the cardiac interior, thereby enabling macroscopic pathological diagnosis. Percutaneous cardioscopy has demonstrated that the endocardial surface exhibits various colors characteristic of different heart diseases. This imaging modality can now be used for evaluation of the severity of myocardial ischemia, and staging of myocarditis. Myocardial blood flow recovery induced by vasodilating agents or percutaneous coronary interventions can be clearly visualized. Morphological and functional changes in the cardiac valves can also be evaluated. Cardioscope-guided endomyocardial biopsy enables pin-point biopsy of the diseased myocardium. Recently, dye-image cardioscopy and fluorescence cardioscopy were developed for evaluation of the subendocardial microcirculation. Cardioscope-guided intracardiac therapies such as myotomy, myectomy, valvulotomy, and transendocardial angiogenic and myogenic therapy have been trialed using animal models in anticipation of future clinical applications. Percutaneous cardioscopy has the potential to contribute to our understanding of heart disease, and to assist in guidance for intracardiac therapies. - Direct observation of changes in the beating heart was previously beyond the scope of any available imaging Intracardiac observation using a rigid cardioscope in animals was performed by Allen et al. in 1922 [1] and by Harken et al. in 1943 [2]. In 1956, Sakakibara et al. [3] employed a rigid cardioscope to observe a septal defect during open-heart surgery. They also observed aortic valves using the same cardioscope in 1958 [4]. Difficulties in producing a thin endoscope that can safely be introduced percutaneously into the cardiac chambers, and equipment that can displace blood, meant that about 29 years elapsed before Uchida and his coworkers successfully performed percutaneous cardioscopy in patients [5, 6]. Although this new modality of diagnosis is now performed routinely in a few selected institutions, it has yet to be adopted on a global scale. In 1975, a 9-F fiberscope was developed in collaboration with Olympus Corporation, Tokyo. This cardioscope was introduced through an 11-F hard-tipped guiding catheter into a canine left ventricle, but was abandoned due to marked damage to the endocardial surface. In 1976, a 10-F balloon-tipped guiding catheter was developed. This catheter allowed the passage of a 6-F fiberscope. However, this cardioscope also had to be abandoned because the balloon became frosty during use due to the temperature difference between the saline used for balloon dilatation and the blood in the ventricle. In the same year, a fiberscope was devised with a balloon at its tip. This fiberscope had a central lumen through which warmed saline at body temperature could be infused to dilate the balloon. The balloon was pushed against the endocardial surface to observe changes through the dilated balloon. However, introduction of this fiberscope into the left ventricle was very difficult because a guide wire could not be used, and if used in combination with a guiding catheter, a big catheter had to be used to allow the fiberscope to pass through. This fiberscope was not used clinically. In 1983, a 9-F balloon-guiding catheter was devised in collaboration with Clinical Supply Company, Gifu, Japan. When inflated with CO2, the balloon protruded more distally than the shaft tip to form a dead space between the target and the balloon, at the same time preventing damage to the myocardium by the shaft tip. In combination with a 5-F fiberscope, this balloon catheter enabled percutaneous transluminal observation of the cardiac chambers and valves (Fig. 1). This cardioscopy system is now routinely used clinically for observation, not only of the cardiac chambers and valves, but also of the great vessels including the pulmonary arteries, caval veins, and aorta. A cardioscopy system comprises a light source, 4.5-F fiberscope, 9-F guiding balloon catheter, intensified chilled coupled device (ICCD) camera, camera controller, DVD recorder, and television monitor. The fiberscope (AF 14, Olympus Corporation) is a 4.5-F fiberscope containing 3,000 glass fibers for image guidance and 300 glass fibers for light guidance. The fiberscope is passed through a 9-F guiding balloon catheter (Clinical Supply Company). The balloon is inflated with CO2. The catheter has a Y connecter at the proximal end: one channel for fiberscope insertion and another for saline flushing. White balance of the cardioscope is adjusted using white gauze that is immersed in saline solution as the white color (Fig. 1) [710]. Cardioscopy Procedures Usually, following coronary angiography and left ventriculography, a guiding balloon catheter is intr (...truncated)


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Yasumi Uchida. Recent Advances in Percutaneous Cardioscopy, Current Cardiovascular Imaging Reports, 2011, pp. 317-327, Volume 4, Issue 4, DOI: 10.1007/s12410-011-9092-6