Hybrid Imaging in the Catheter Laboratory: Real-time Fusion of Echocardiography and Fluoroscopy During Percutaneous Structural Heart Disease Interventions

Abstract

Percutaneous catheter-based techniques for the treatment of structural heart disease are becoming more complex, and current imaging techniques have limitations: while fluoroscopy gives poor visualisation of cardiac anatomical structures, echocardiography is limited in its ability to detect the position of catheters and devices. The EchoNavigator® (Philips) live image guidance tool is a novel system that integrates real-time echocardiography with fluoroscopic X-ray imaging, optimising the guidance and positioning of devices. Use of the EchoNavigator system facilitates improved understanding of anatomical structures while showing enhanced visualisation of catheter and device movements. Early clinical experience suggests that the technology is feasible and safe, and provides enhanced understanding of the relationship between soft tissue anatomy and catheter devices in structural heart disease. The use of the EchoNavigator system can improve the confidence of interventional cardiologists in the targeting and positioning of devices in percutaneous interventions in structural heart disease, and has the potential to reduce procedural time, reduce the dosage of contrast and radiation and increase safety in the performance of procedural steps.

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 – 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 ].…”

Catheter segmentation in X-ray fluoroscopy using synthetic data and transfer learning with light U-nets

“…Other imaging modalities with potential to improve endovascular guidance are magnetic resonance imaging (MRI), computed tomography (CT) and 3d rotational X-ray angiography, typically performed pre-operatively. Fusing multiple imaging modalities and developing computer vision techniques to enhance tool visualization can lead to accurate and robust localization of the catheter, with reduced use of fluoroscopy [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] . In many situations this requires registration of 3d pre-operative data to 2d intra-operative fluoroscopy images, of which a key aspect is the ability to accurately localize and segment the catheter in the X-ray fluoroscopic images.…”

Paravalvular leak closure with real time transesophageal echocardiography and fluoroscopy fusion

“…The EchoNavigator software has been used previously in percutaneous interventions for structural heart disease including: transapical TAVI procedures, atrial septal defect closure, left atrial appendage closure and mitral valve clip procedures. 7 Our report highlights how fusion of real-time TEE and fluoroscopy imaging with the EchoNavigator system facilitates transcatheter paravalvular leak closure. Improved imaging guides the procedure making it quicker and safer leading to better outcomes.…”