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


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.


3D3D registration Congenital heart disease Acquired pulmonary vein stenosis Intervention 



Magnetic resonance angiography


Percutaneous pulmonary valve implantation


Pulmonary vein stenosis


Pulmonary vein isolation


Left pulmonary artery



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


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.


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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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