Advertisement

Pediatric Cardiology

, Volume 38, Issue 6, pp 1133–1142 | Cite as

Novel Three-Dimensional Image Fusion Software to Facilitate Guidance of Complex Cardiac Catheterization

3D image fusion for interventions in CHD
  • Sebastian GorecznyEmail author
  • Pawel Dryzek
  • Gareth J. Morgan
  • Maciej Lukaszewski
  • Jadwiga A. Moll
  • Tomasz Moszura
Original Article

Abstract

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.

Keywords

3D guidance Road mapping Stenting VesselNavigator 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

246_2017_1627_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 18 kb)
246_2017_1627_MOESM2_ESM.docx (21 kb)
Supplementary material 2 (DOCX 20 kb)
246_2017_1627_MOESM3_ESM.docx (19 kb)
Supplementary material 3 (DOCX 18 kb)

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)

References

  1. 1.
    Glatz AC, Zhu X, Gillespie MJ, Hanna BD, Rome JJ (2010) Use of angiographic CT imaging in the cardiac catheterization laboratory for congenital heart disease. JACC Cardiovasc Imaging 3:1149–1157CrossRefPubMedGoogle Scholar
  2. 2.
    Berman DP, Khan DM, Gutierrez Y, Zahn EM (2012) The use of three-dimensional rotational angiography to assess the pulmonary circulation following cavo-pulmonary connection in patients with single ventricle. Catheter Cardiovasc Interv. 80:922–930CrossRefPubMedGoogle Scholar
  3. 3.
    Glöckler M, Halbfaβ J, Koch A, Achenbach S, Dittrich S (2013) Multimodality 3D-roadmap for cardiovascular interventions in congenital heart disease a single-center, retrospective analysis of 78 cases. Catheter Cardiovasc Interv. 82:436–442CrossRefPubMedGoogle Scholar
  4. 4.
    Goreczny S, Morgan GJ, Dryzek P (2016) Live 3D image overlay for arterial duct closure with Amplatzer Duct Occluder II additional size. Cardiol Young 26:605–608CrossRefPubMedGoogle Scholar
  5. 5.
    Peters M, Krings G, Koster M, Molenschot M, Freund MW, Breur JM (2015) Effective radiation dosage of three-dimensional rotational angiography in children. Europace 17:611–616CrossRefPubMedGoogle Scholar
  6. 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. 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
  8. 8.
    Tomkowiak MT, Klein AJ, Vigen KK, Hacker TA, Speidel MA, VanLysel MS, Raval AN (2011) Targeted transendocardial therapeutic delivery guided by MRI-x-ray image fusion. Catheter Cardiovasc Interv 78:468–478PubMedGoogle Scholar
  9. 9.
    Dori Y, Sarmiento M, Glatz AC, Gillespie MJ, Jones VM, Harris MA, Whitehead KK, Fogel MA, Rome JJ (2011) X-ray magnetic resonance fusion to internal markers and utility in congenital heart disease catheterization. Circ Cardiovasc Imaging 4:415–424CrossRefPubMedPubMedCentralGoogle Scholar
  10. 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. 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. 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
  13. 13.
    Stangenberg L, Shuja F, Carelsen B, Elenbaas T, Wyers MC, Schermerhorn ML (2015) A novel tool for three-dimensional roadmapping reduces radiation exposure and contrast agent dose in complex endovascular interventions. J Vasc Surg 62:448–455CrossRefPubMedGoogle Scholar
  14. 14.
    Fagan TE, Truong UT, Jone PN, Bracken J, Quaife R, Hazeem AA, Salcedo EE, Fonseca BM (2014) Multimodality 3 dimensional image integration for congenital cardiac catheterization. Methodist Debakey Cardiovasc J 10:68–76CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Goreczny S, Dryzek P, Moszura T (2016) Use of pre-intervention imaging with a novel image fusion software for guidance of cardiac catheterisation in a patient with pulmonary atresia and major aortopulmonary collaterals. Cardiol Young. doi: 10.1017/S1047951116000895 Google Scholar
  16. 16.
    Goreczny S, Dryzek P, Moszura T (2016) Novel 3-dimensional image fusion software for live guidance of percutaneous pulmonary valve implantation. Circ Cardiovasc Interv. doi: 10.1161/CIRCINTERVENTIONS.116.003711 PubMedGoogle Scholar
  17. 17.
    Faranesh AZ, Kellman P, Ratnayaka K, Lederman RJ (2013) Integration of cardiac and respiratory motion into MRI roadmaps fused with x-ray. Med Phys 40:032302CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of CardiologyPolish Mother’s Memorial Hospital, Research InstituteLodzPoland
  2. 2.Heart Institute, Children’s Hospital of Colorado & Department of Adult Congenital Heart DiseaseUniversity of Colorado HospitalDenverUSA
  3. 3.Department of RadiologyPolish Mother’s Memorial Hospital, Research InstituteLodzPoland

Personalised recommendations