Multimodality 3-Dimensional Image Integration for Congenital Cardiac Catheterization

Abstract

Background Cardiac catheterization remains the standard diagnostic technique for assessing both anatomy and physiology in congenital heart disease (Chd). fixed projection angiography (fpa) is the mainstay for guiding congenital cardiovascular interventions. however, fpa has limitations in soft tissue visualization and precise characterization of complex structures such as segmental branch pulmonary arteries, coronary arteries, and anomalous or stenotic pulmonary veins. these limitations are due in part to simultaneous opacification of overlying structures, foreshortening of structures if the projection is not perfectly aligned, and the inability to visualize structures without injection of contrast. integration of 3-dimensional (3d) image data sets with fluoroscopy can potentially overcome limitations of 2-dimensional (2d) angiography for visualizing complex vascular structures and can facilitate accurate diagnoses as well as guide interventional procedures. the use of 3d images obtained from 3d rotational angiography (3dra), Ct, and Mri was originally developed for neuroradiographic endovascular procedures 1-3 but has played an increasing role in cardiovascular medicine for anatomic delineation 4-7 and electroanatomic mapping. 8 rotational angiography (ra) and 3dra have emerged as promising modalities applicable to congenital cardiac diagnosis. 7, 9 additionally, integrated 3d images from 3dra, Ct, and Mri overlaid onto live fluoroscopy are now being used for roadmaps to guide Chd diagnostic and interventional procedures. 5, 6, 10 the potential benefits of integrating 3d images into fluoroscopic procedures for Chd are many, including: (1) improved diagnostic and interventional efficacy, (2) reduced overall radiation exposure, (3) reduced contrast dose, and (4) reduced procedural time. 11-13 all of these are particularly advantageous in the pediatric population. parallel to this, 3d transesophageal echocardiography (3d-tee) is currently being applied to Chd catheterization procedures. this technology allows real-time anatomic visualization of soft tissue structures and catheter guidance within the beating heart.

X‐ray fused with MRI guidance of pre‐selected transcatheter congenital heart disease interventions

“…To facilitate complex structural interventions, operators often perform pre‐procedure three‐dimensional (3D) imaging and use adjunctive procedural imaging such as transesophageal or intracardiac echocardiography. Fusion imaging, overlaying 3D images from cardiac MRI, CT, 3D rotational angiography (3DRA), or echocardiography on live fluoroscopy, may aid complex interventions . Patients with congenital heart disease have complex cardiac and post‐surgical anatomy often resulting in relatively long procedure times requiring multiple contrast injections and adjunct 3D imaging to guide interventions.…”

“…Fusion imaging, overlaying 3D images from cardiac MRI, CT, 3D rotational angiography (3DRA), or echocardiography on live fluoroscopy, may aid complex interventions. 1 Patients with congenital heart disease have complex cardiac and post-surgical anatomy often resulting in relatively long procedure times requiring multiple contrast injections and adjunct 3D imaging to guide interventions. Many of these patients require multiple lifetime cardiac catheterizations and other examinations contributing to significant cumulative radiation exposure.…”

Three-dimensional modelling and three-dimensional printing in pediatric and congenital cardiac surgery

“…In the cardiovascular domain, these imaging technologies include 3D echocardiography/ultrasound, 3D rotational angiography, computer-tomography (CT) and magnetic resonance (MR) imaging. They provide accurate direct information of the anatomy and in/directly of the hemodynamic consequences (3). Image data integration of these modalities will enhance 3D multimodality modelling with grossly improved reliability, accuracy and resolution (4).…”

Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy

“…Percutaneous interventions such as MitraClip (Abbott Vascular, Santa Clara, California, USA) implantation and left atrial appendage (LAA) closure require a precise transseptal puncture (TSP) in a prespecified region of the interatrial septum [1, 2]. Therefore, visual guidance through 2D and/or 3D echocardiography in addition to fluoroscopy is essential for a successful performance, since only echocardiography depicts anatomic soft tissue structures [3].…”