Left ventricular contrast injection with rotational C-arm CT improves accuracy of aortic annulus measurement during cardiac catheterisation

Balzer, Jan C.; Boering, Yang Chul; Mollus, Sabine; Schmidt, M; Hellhammer, Katharina; Kroepil, Patrick; Westenfeld, Ralf; Zeus, Tobias; Antoch, Gerald; Linke, Axel; Steinseifer, Ulrich; Merx, Marc W.; Kelm, Malte

doi:10.4244/eijv10i3a60

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…RCT was performed as part of the pre-implant diagnostic coronary angiography study[13]. The C-arm of the Cathlab system (Allura FD 20, 30 cm flat panel detector, XperCT option, Philips Healthcare, Andover, MA, United States) was rotated over an angular range of 210° with a sweep duration of 5.2 s and a frame-rate of 60 frames/s around the patient.…”

Section: Methodsmentioning

confidence: 99%

“…Two independent, blinded observers performed aortic root diameter measurements in multiplanar reformatted RCT data sets at the level of the aortic annulus, the aortic sinus and the sino-tubular junction (STJ). These are supposed to be representative for the shape and dimensions of the aortic root anatomy to be overlaid to the fluoroscopic data stream for intervention guidance[13]. …”

Section: Methodsmentioning

confidence: 99%

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Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model

Veulemans¹,

Mollus²,

Saalbach³

et al. 2016

WJC

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AIMTo investigate the accuracy of a rotational C-arm CT-based 3D heart model to predict an optimal C-arm configuration during transcatheter aortic valve replacement (TAVR).METHODSRotational C-arm CT (RCT) under rapid ventricular pacing was performed in 57 consecutive patients with severe aortic stenosis as part of the pre-procedural cardiac catheterization. With prototype software each RCT data set was segmented using a 3D heart model. From that the line of perpendicularity curve was obtained that generates a perpendicular view of the aortic annulus according to the right-cusp rule. To evaluate the accuracy of a model-based overlay we compared model- and expert-derived aortic root diameters.RESULTSFor all 57 patients in the RCT cohort diameter measurements were obtained from two independent operators and were compared to the model-based measurements. The inter-observer variability was measured to be in the range of 0°-12.96° of angular C-arm displacement for two independent operators. The model-to-operator agreement was 0°-13.82°. The model-based and expert measurements of aortic root diameters evaluated at the aortic annulus (r = 0.79, P < 0.01), the aortic sinus (r = 0.93, P < 0.01) and the sino-tubular junction (r = 0.92, P < 0.01) correlated on a high level and the Bland-Altman analysis showed good agreement. The interobserver measurements did not show a significant bias.CONCLUSIONAutomatic segmentation of the aortic root using an anatomical model can accurately predict an optimal C-arm configuration, potentially simplifying current clinical workflows before and during TAVR.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model

Veulemans¹,

Mollus²,

Saalbach³

et al. 2016

WJC

Self Cite

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“…41 Furthermore, compared to pre-procedural CT, the radiation and contrast exposure of CBCT is significantly lower. 11,22 TEE-XRF fusion is increasingly used in mitral valve repair and various CHD procedures. The major advantage is the use of real-time fusion of two important imaging modalities.…”

Section: Discussionmentioning

confidence: 99%

“…The reported radiation and contrast levels for CBCT are significantly lower than the median radiation exposure used in adult cardiac CT, especially with optimized CBCT protocols. [10][11][12][13][14][15] When used only for anatomical guidance during HI, CBCT is therefore the preferred modality. Moreover, a beneficial effect of CBCT + XRF-based interventions compared to XRF interventions alone on skin dose is seen in patients.…”

Section: Peri-procedurally Acquired Imagingmentioning

confidence: 99%

“…12,14,18 Several studies have shown that standardized acquisition and contrast protocols have a beneficial effect on radiation exposure and contrast use during SHD (Table 3). [10][11][12][13] Siemens systems require a short image acquisition to be done before starting the DynaCT to calibrate the CBCT settings. Too short image acquisition may result in high tube currents and therefore an unnecessary increase in radiation dose.…”

Section: Peri-procedurally Acquired Imagingmentioning

confidence: 99%

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3D Hybrid Imaging for Structural and Congenital Heart Interventions in the Cath Lab

Broek

Krings

et al. 2018

Structural Heart

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Hybrid imaging (HI) during cardiovascular interventions enables the peri-procedural visualization of the organs and tissues by means of integrating different imaging modalities. HI can improve the procedural efficacy and safety. This review provides an overview of different systems, their possibilities and the current clinical use and benefits focused on structural and congenital heart diseases. We have performed a literature search and linked the software options to the clinical use in cardiology to gain insight into the clinical use of the systems. In this review, we focus on radiation and contrast exposure, complication rate and procedure time. We found that currently available studies are limited by small cohorts. Nevertheless, HI systems for valvular procedures result in a significant decrease of radiation and contrast exposure. The largest benefit hereof is observed when HI is used in combination with rotational angiography. Furthermore, automatically determined optimal implant angle for transcatheter aortic valve implantation decreases the complication rate significantly. Congenital heart disease interventions that require 2D/3D Transoesophageal echocardiography (TEE) such as septal defects show a significant decrease in radiation and contrast exposure and procedural time when using TEE-Mono-and bi-plane cine angiography and fluoroscopy (XRF) fusion software. MitraClip procedures using these HI systems, however, show only a trend in decrease of these effects. In conclusion, major interventional X-ray vendors offer HI software solutions which are safe and can aid the planning and image guidance of cardiovascular interventions. Even though current HI technologies have limitations, HI provides support in the increasingly complex cardiac interventional procedures to provide better patient care.

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Planning the Procedure

Feuchtner

Ho²,

Pozzoli

et al. 2020

Multimodality Imaging for Cardiac Valvular Interventions, Volume 1 Aortic Valve

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Left ventricular contrast injection with rotational C-arm CT improves accuracy of aortic annulus measurement during cardiac catheterisation

Abstract: Cardiac catheterisation including LV-RCT offers complementary assessment of left ventricular function, aortic valve anatomy, coronary angiography and arterial access routes. LV-RCT for aortic root measurements shows better correlation to MDCT than standard Ao-RCT protocols.

Cited by 5 publications

References 14 publications

Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model

Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model

3D Hybrid Imaging for Structural and Congenital Heart Interventions in the Cath Lab

Planning the Procedure

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