Cardiac imaging with echocardiography and fluoroscopy (Heart Imaging)

Automated anatomical intelligence: next-generation fusion imaging in structural cardiac interventions.

Cardiac teams performing structural cardiac interventions face unique imaging difficulties, including separate image orientation and different imaging capabilities of the techniques involved.

Special software (EchoNavigator, Philips Health Care, Best, The Netherlands) allows fusion of three-dimensional trans-phageal echocardiography and fluoroscopy to address such shortcomings. However, visualization of complex anatomical structures and interventional precision in the beating heart remain a challenge.

Novel EchoNavigator software (examination device) with anatomical intelligence automatically generates a heart model with delineation of critical anatomical landmarks [PanelA1; left ventricle and aortic root model with aortic valve cusp nadirs (yellow triangles)]. Joint registration with the C-arm and the use of electrocardiogram gating allow live overlay of the model during fluoroscopy (PanelA2, online supplementary material, Video S1).

TAVI

During transcatheter aortic valve implantation, model overlay can be used for optimal alignment of the annular plane before prosthesis implantation without the use of a contrast agent (dotted line on the needles in panelA3, supplemental online material, video S2) or for correct positioning of a temporary pacing lead ( arrowhead in panels B1 and B2 and supplemental online material (video S3 showing the heart at different angles).

MitraClip

During the MitraClip procedure (supplementary online material, video S4), the overlay of the heart model (panelC1) and the automatically generated anatomical landmarks such as the opening of the left superior pulmonary vein (white triangle), the opening of the left atrial appendage (purple circle), and the mitral ring (arrow, panelC2) ensure precise and safe catheter passage through the vulnerable left atrium. Advanced imaging technologies can therefore play an important rule to increase the efficacy and safety of structural cardiac interventions.

- – – –

Supplementary material is available at European Heart Journal online.

European Heart Journal, Volume 38, Issue 18,

Patric Biaggi, Niels Nijhof, Roberto Corti: (Published: 20 October 2016)(PDF)

Source: Published on behalf of the European Society of Cardiology.