Anatomy of Right Atrial Structures by Real-Time 3D Transesophageal Echocardiography

Abstract

The rapid development of catheter ablation techniques for atrial arrhythmias has triggered a renewed interest in the anatomy of the right atrium. In particular, some atrial arrhythmias such as focal atrial arrhythmias or atrial flutter have been linked to the anatomic architecture of specific structures such as the crista terminalis or cavotricuspid isthmus. Real-time 3-dimensional transesophageal echocardiography (RT 3D TEE) is a recently developed technique that provides 3D images of unprecedented quality. Because the right atrium is very close to the transducer, this technique may provide high-quality images of those atrial structures involved in ablation procedures. This review describes a step-by-step approach for acquisition and processing of RT 3D TEE images of right atrial structures of relevance to electrophysiologists. For anatomical correlations of RT 3D TEE images, selected images of right atrial structures were matched to anatomical specimens.

Biatrial Appendage Thrombi in a Heart Failure Patient With Sinus Rhythm

“…Multiplane TEE (eg, midesophageal bicaval view, 90°; view, 150°) is useful for visualizing right atrial appendage thrombus. Real-time 3-dimensional TEE is also useful for visualizing right atrial structures, 4 and allows detailed assessment of the extent of right atrial mural thrombus.…”

Value of Real-Time Transesophageal 3-Dimensional Echocardiography in Guiding Ablation of Isthmus-Dependent Atrial Flutter and Pulmonary Vein Isolation

“…16 The right and left atria are very close to the esophagus and specific right and left atrial anatomical structures can be accurately visualized by RT 3D TEE. 17 Some of these structures, such as the CVTI or PV ostia, are target of specific ablation procedures (CVTI or PV isolation). Moreover, RT 3D TEE has been shown to have enough temporal and spatial resolution to potentially track catheter movement in the heart, thus enabling real-time navigation of ablation catheters.…”

“…17 Briefly, it is a matrix probe with 2,500 elements capable of 2 different "real-time" acquisition modalities: "live 3D" and "3D zoom". The "live 3D" modality switches the system from 2D to 3D imaging, acquiring real-time 3D images without electrocardiographic-gating reconstruction.…”

“…17 From this perspective, the entire CVTI is imaged, including the coronary sinus ostium, the Eustachian valve (EV)/ridge, the pectinate muscles, and the posterior tricuspid hinge line (Figures 1A,B). The interventional electrophysiologist may not be familiar with 3D TEE imaging.…”

“…17 When the septum is acquired in the "en face" perspective, a 90° rotation from that perspective will disclose the right PVs ostia (Figure 3B). …”