Echocardiography–fluoroscopy fusion imaging: The essential features used in congenital and structural heart disease interventional guidance

Abstract

Increased catheter-based interventions in congenital and structural heart disease require imaging modalities to be oriented in the same visual perspective. The use of echocardiography-fluoroscopy fusion (EFF) imaging has been developed for better characterization of complex anatomy and to facilitate key steps in interventional procedures. This review will detail the technology behind EFF, the differences between the two ultrasound fusion systems, and essential features of EFF imaging in congenital and structural heart disease interventions.

Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging

“…Other features including color overlay and 3D anatomic rendering additional valuable information to guide specific interventions. Such exposition of the target lesion/cardiac structure facilitates precise catheter manipulation for crossing of defects or positioning of devices and has been proven useful for ASD and VSD closure, specifically in fenestrated defects ( 79 , 80 ), percutaneous pulmonary and tricuspid valve implant ( 79 , 81 ), transeptal puncture and Fontan fenestration creation ( 69 , 82 ), mitral valve procedures ( 83 , 84 ) and paravalvular leak closures ( 82 ). Several centers have reported decreased fluoroscopy time and radiation dose when using EFF for ASD closure ( 79 ).…”

“…In comparison to image fusion with high resolution CT/MRI, inherent drawbacks of 3D TEE fusion include the limited field of view especially with imaging of anterior structures, variable 3D image resolution, and susceptibility to interference from interventional equipment. Currently, the use of EFF is restricted to patients weighing > 20kgs because the adult 3D TEE probe cannot be placed in small patients ( 82 ).…”

Commentary: Use fusion to avoid confusion

“… 1 The utility of this technology during performance of high-complexity hybrid procedures has been well documented. 1 , 2 , 3 …”

“…1 The utility of this technology during performance of high-complexity hybrid procedures has been well documented. [1][2][3] In this issue of the Journal, Anselmi and colleagues 4 describe use of fusion of 3D TEE and computed tomography (CT) images of the mitral valve in conjunction with conventional fluoroscopy. This technique was used to facilitate placement of a transcatheter mitral valve implantation using a transapically delivered, apically tethered, and selfexpandable prosthesis (Tendyne device; Abbott Laboratories, Abbott Park, Ill) in a patient with severe mitral annular calcification.…”