Novel Three-Dimensional Image Fusion Software to Facilitate Guidance of Complex Cardiac Catheterization
- 498 Downloads
We report initial experience with novel three-dimensional (3D) image fusion software for guidance of transcatheter interventions in congenital heart disease. Developments in fusion imaging have facilitated the integration of 3D roadmaps from computed tomography or magnetic resonance imaging datasets. The latest software allows live fusion of two-dimensional (2D) fluoroscopy with pre-registered 3D roadmaps. We reviewed all cardiac catheterizations guided with this software (Philips VesselNavigator). Pre-catheterization imaging and catheterization data were collected focusing on fusion of 3D roadmap, intervention guidance, contrast and radiation exposure. From 09/2015 until 06/2016, VesselNavigator was applied in 34 patients for guidance (n = 28) or planning (n = 6) of cardiac catheterization. In all 28 patients successful 2D–3D registration was performed. Bony structures combined with the cardiovascular silhouette were used for fusion in 26 patients (93%), calcifications in 9 (32%), previously implanted devices in 8 (29%) and low-volume contrast injection in 7 patients (25%). Accurate initial 3D roadmap alignment was achieved in 25 patients (89%). Six patients (22%) required realignment during the procedure due to distortion of the anatomy after introduction of stiff equipment. Overall, VesselNavigator was applied successfully in 27 patients (96%) without any complications related to 3D image overlay. VesselNavigator was useful in guidance of nearly all of cardiac catheterizations. The combination of anatomical markers and low-volume contrast injections allowed reliable 2D–3D registration in the vast majority of patients.
Keywords3D guidance Road mapping Stenting VesselNavigator
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interests.
Informed consent was obtained from all individual participants included in the study.
Video 1 VesselNavigator assisted percutaneous pulmonary valve implantation in an 11 year-old patient with common arterial trunk after homograft repair. Supplementary material 4 (MP4 26431 kb)
Video 2 VesselNavigator assisted recoarctation stenting in a 13 year-old patient. Supplementary material 5 (MP4 18747 kb)
Video 3 VesselNavigator assisted ductus arteriosus stent implantation in a neonate with hypoplastic left heart syndrome after bilateral pulmonary artery banding. Supplementary material 6 (MP4 24475 kb)
Video 4. VesselNavigator assisted hypoplastic left pulmonary artery stent implantation in a 6 year-old with tetralogy of Fallot after homograft repair. Supplementary material 7 (MP4 34318 kb)
- 6.Haddad L, Waller BR, Johnson J, Choudhri A, McGhee V, Zurakowski D, Kuhls-Gilcrist A, Sathanandam S (2016) Radiation protocol for three-dimensional rotational angiography to limit procedural radiation exposure in the Pediatric Cardiac Catheterization Lab. Congenit Heart Dis. doi: 10.1111/chd.12356 PubMedGoogle Scholar
- 7.Ratnayaka K, Raman VK, Faranesh AZ, Sonmez M, Kim JH, Gutiérrez LF, Ozturk C, McVeigh ER, Slack MC, Lederman RJ (2009) Antegrade percutaneous closure of membranous ventricular septal defect using X-ray fused with magnetic resonance imaging. JACC Cardiovasc Interv. 2:224–230CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Abu Hazeem AA, Dori Y, Whitehead KK, Harris MA, Fogel MA, Gillespie MJ, Rome JJ, Glatz AC (2014) X-ray magnetic resonance fusion modality may reduce radiation exposure and contrast dose in diagnostic cardiac catheterization of congenital heart disease. Catheter Cardiovasc Interv 84:795–800CrossRefPubMedGoogle Scholar
- 11.Kliger C, Jelnin V, Sharma S, Panagopoulos G, Einhorn BN, Kumar R, Cuesta F, Maranan L, Kronzon I, Carelsen B, Cohen H, Perk G, Van Den Boomen R, Sahyoun C, Ruiz CE (2014) CT angiography-fluoroscopy fusion imaging for percutaneous transapical access. JACC Cardiovasc Imaging 7:169–177CrossRefPubMedGoogle Scholar
- 12.Tacher V, Lin M, Desgranges P, Deux JF, Grünhagen T, Becquemin JP, Luciani A, Rahmouni A, Kobeiter H (2013) Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion. J Vasc Interv Radiol 24:1698–1706CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Goreczny S, Moszura T, Dryzek P, Lukaszewski M, Krawczuk A, Moll J, Morgan GJ (2017) Three-dimensional image fusion guidance of percutaneous pulmonary valve implantation to reduce radiation exposure and contrast dose: A comparison with traditional two-dimensional and three-dimensional rotational angiographic guidance. Neth Heart J 25:91–99CrossRefPubMedGoogle Scholar