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

  • Patcharapong Suntharos
  • Randolph M. Setser
  • Sharon Bradley-Skelton
  • Lourdes R. Prieto
Original Paper

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.

Keywords

3D3D registration Congenital heart disease Acquired pulmonary vein stenosis Intervention 

Abbreviations

MRA

Magnetic resonance angiography

PPVI

Percutaneous pulmonary valve implantation

PVS

Pulmonary vein stenosis

PVI

Pulmonary vein isolation

LPA

Left pulmonary artery

Notes

Acknowledgements

Support for this study was provided by Siemens Healthcare. Dr. Setser is an employee of Siemens Medical Solutions. Other authors have nothing to disclose.

Funding

Financial support for IRB fees, software used for this research project, database development and maintenance were provide by Siemens Medical Solutions, USA.

Compliance with ethical standards

Conflict of interest

Dr. Setser is an employee of Siemens Medical Solutions. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

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

References

  1. 1.
    Pockett CR, Moore JW, El-Said HG (2017) Three dimensional rotational angiography for assessment of coronary arteries during Melody valve implantation: introducing a technique that may improve outcomes. Neth Heart J 25(2):82–90CrossRefPubMedGoogle Scholar
  2. 2.
    Nasis A, Mottram PM, Cameron JD, Seneviratne SK (2013) Current and evolving clinical applications of multidetector cardiac CT in assessment of structural heart disease. Radiology 267:11–25CrossRefPubMedGoogle Scholar
  3. 3.
    Sørensen TS, Körperich H, Greil GF, Eichhorn J, Barth P, Meyer H, Pedersen EM, Beerbaum P (2004) Operator-independent isotropic three-dimensional magnetic resonance imaging for morphology in congenital heart disease: a validation study. Circulation 110:163–169CrossRefPubMedGoogle Scholar
  4. 4.
    Krishnaswamy A, Tuzcu EM, Kapadia SR (2011) Three-dimensional computed tomography in the cardiac catheterization laboratory. Catheter Cardiovasc Interv 77:860–865CrossRefPubMedGoogle Scholar
  5. 5.
    Krishnaswamy A, Tuzcu EM, Kapadia SR (2015) Integration of MDCT and fluoroscopy using C-arm computed tomography to guide structural cardiac interventions in the cardiac catheterization laboratory. Catheter Cardiovasc Interv 85(1):139–147CrossRefPubMedGoogle Scholar
  6. 6.
    Kliger K, 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(2):169–177CrossRefPubMedGoogle Scholar
  7. 7.
    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
  8. 8.
    Glöckler M, Halbfaß 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
  9. 9.
    Rajiah P, Setser RM, Desai MY, Flamm SD, Arruda JM (2011) Utility of free breathing whole heart 3D magnetic resonance imaging in the assessment of coronary anatomy in congenital heart disease. Pediatr Cardiol 32:418–425CrossRefPubMedGoogle Scholar
  10. 10.
    Glöckler M, Koch A, Greim V, Shabaiek A, Rüffer A, Cesnjevar R, Achenbach S, Dittrich S (2011) The value of flat-detector computed tomography during catheterisation of congenital heart disease. Eur Radiol 21:2511–2520CrossRefPubMedGoogle Scholar
  11. 11.
    Ahmed MI, Escañuela MG, Crosland WA, McMahon WS, Alli OO, Nanda NC (2014) Utility of live/real time three-dimensional transesophageal echocardiography in the assessment and percutaneous intervention of bioprosthetic pulmonary valve stenosis. Echocardiography 31(4):531–533CrossRefPubMedGoogle Scholar
  12. 12.
    Silvestry FE, Kadakia MB, Willhide J, Herrmann HC (2014) Initial experience with a novel real-time three-dimensional intracardiac ultrasound system to guide percutaneous cardiac structural interventions: a phase 1 feasibility study of volume intracardiac echocardiography in the assessment of patients with structural heart disease undergoing percutaneous transcatheter therapy. J Am Soc Echocardiogr 27(9):978–983CrossRefPubMedGoogle Scholar
  13. 13.
    Razavi R, Hill DLG, Keevil SF, Miquel ME, Muthurangu V, Hegde S, Rhode K, Barnett M, van Vaals J, Hawkes DJ, Baker E (2003) Cardiac catheterization guided by MRI in children and adults with congenital heart disease. Lancet 362:1877–1882CrossRefPubMedGoogle Scholar
  14. 14.
    Rogers T, Lederman RJ, Interventional CMR (2015) Clinical applications and future directions. Curr Cardiol Rep 17(5):31CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    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(2):91–99CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Department of Pediatric CardiologyCleveland Clinic Children’sClevelandUSA
  2. 2.Siemens Medical Solutions USA, Inc.MalvernUSA

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