Real-time three dimensional CT and MRI to guide interventions for congenital heart disease and acquired pulmonary vein stenosis

Abstract

To validate the feasibility and spatial accuracy of pre-procedural 3D images to 3D rotational fluoroscopy registration to guide interventional procedures in patients with congenital heart disease and acquired pulmonary vein stenosis. Cardiac interventions in patients with congenital and structural heart disease require complex catheter manipulation. Current technology allows registration of the anatomy obtained from 3D CT and/or MRI to be overlaid onto fluoroscopy. Thirty patients scheduled for interventional procedures from 12/2012 to 8/2015 were prospectively recruited. A C-arm CT using a biplane C-arm system (Artis zee, VC14H, Siemens Healthcare) was acquired to enable 3D3D registration with pre-procedural images. Following successful image fusion, the anatomic landmarks marked in pre-procedural images were overlaid on live fluoroscopy. The accuracy of image registration was determined by measuring the distance between overlay markers and a reference point in the image. The clinical utility of the registration was evaluated as either "High", "Medium" or "None". Seventeen patients with congenital heart disease and 13 with acquired pulmonary vein stenosis were enrolled. Accuracy and benefit of registration were not evaluated in two patients due to suboptimal images. The distance between the marker and the actual anatomical location was 0-2 mm in 18 (64%), 2-4 mm in 3 (11%) and >4 mm in 7 (25%) patients. 3D3D registration was highly beneficial in 18 (64%), intermediate in 3 (11%), and not beneficial in 7 (25%) patients. 3D3D registration can facilitate complex congenital and structural interventions. It may reduce procedure time, radiation and contrast dose.

Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure

“…From a theoretical perspective, it should be an advantage to combine and fuse the complementary information of different imaging modalities like ultrasound and fluoroscopy instead of only simultaneously displaying these images on separate screens. Therefore, several technical solutions for fusion imaging have been established that are nowadays commercially available [3][4][5]. However, to date, there are only a very limited number of studies which have shown the feasibility and safety of dynamic fusing imaging of TEE and fluoroscopy during cardiac interventions [6], and only one small study with a number limitations has pointed out towards a clinical advantage of the use of FI during interventional LAA closure [7].…”

Acute and medium term results of balloon expandable stent placement in the transverse arch—a multicenter pediatric interventional cardiology early career society study

“…With recent improvements in imaging software, 3D virtual models can be created from pre‐catheterization CT or MRI data 28,29 . More recently, fusion imaging allows these reconstructions to be overlaid on the fluoroscopy and used as roadmaps to guide transcatheter interventions 30,31 …”

“…28,29 More recently, fusion imaging allows these reconstructions to be overlaid on the fluoroscopy and used as roadmaps to guide transcatheter interventions. 30,31 Hypertension was a common finding in patients with transverse arch narrowing. With successful relief of angiographic stenosis and resolution of pressure gradient, the right arm blood pressure decreased post intervention in comparison to preintervention.…”

3D Approaches in Complex CHD: Where Are We? Funny Printing and Beautiful Images, or a Useful Tool?

“…The feasibility and spatial accuracy of pre-procedural 3D CT and MRI images to 3D rotational fluoroscopy registration to guide interventional procedures in patients with congenital heart disease has also been investigated. This technology displays great potential in integrating three-dimensional imaging in the catheterisation laboratory to reduce procedure time, radiation and contrast dose [ 45 ]. Assessing coronary arteries remains relevant in patients with congenital heart disease, and recent work fusing resting 3D echocardiography-derived myocardial deformation with coronary CT angiography permits a simultaneous assessment of the degree of coronary stenosis and its haemodynamic significance.…”