Pulsed Cavitational Ultrasound Softening

Figures

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  Figure 1. Image-Guided Therapy Setup The imaging probe was fixed through a hole in the center of the pulsed cavitational ultrasound therapy transducer.

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  Figure 2. Experimental and In Vivo Procedures (A) In vitro procedure setup. (B) Photography of a part of the in vitro setup. The bioprosthesis (A) was placed in front of the therapy device composed of a therapy transducer (C) and an imaging transducer (D). The 2 pressure sensors (B) were positioned before and after the valve. (C) In vivo procedure, in the beating heart. The bioprosthesis was implanted in the mitral position, between the LA and the LV. The Swan-Ganz catheter (blue, to estimate the cardiac flow in real time), was positioned into the right heart (RV and RA) and the pulmonary artery. The Millar catheters (green), were positioned into the LA and LV to estimate the transvalvular gradient in real time. PCU was then applied all over the bioprosthesis by moving the therapy device using the 3-axis motorized stage. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.

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  Figure 3. In Vitro Results Mean transvalvular gradient measured before and after pulsed cavitational ultrasound.

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  Supplemental Video 1 In vivo procedure of pulsed cavitational ultrasound therapy

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  Figure 5. Results In Vivo, Before and After Pulsed Cavitational Focused Ultrasound BP = blood pressure; HR = heart rate; PHT = pressure half-time method.

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  Figure 6. Macroscopic Postmortem Analysis Macroscopic analysis showed that all cardiac structures were intact. The whole hearts appeared intact from the outside, with no visible damage on the epicardial surfaces (except in 2 animals in which a 7-mm diameter superficial hematoma [epicardium] was visible). After dissection, no damage was observed inside of the heart.

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  Figure 7. Elastography (A) Example of bioprosthesis elastography in vitro by shear wave elastography. (B) Elastrography results (in vitro and in vivo).

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  Figure 8. Histological Analysis After pulsed cavitational focused ultrasound, the superficial structures remain intact (A). An aspect of calcification fragmentation is visible (B). Some vacuoles are also found inside of the calcifications (C).