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Bertsche D, Rottbauer W, Rasche V, Buckert D, Markovic S, Metze P, Gonska B, Luo E, Dahme T, Vernikouskaya I, Schneider LM. Computed tomography angiography/magnetic resonance imaging-based preprocedural planning and guidance in the interventional treatment of structural heart disease. Front Cardiovasc Med 2022; 9:931959. [PMID: 36324746 PMCID: PMC9620519 DOI: 10.3389/fcvm.2022.931959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022] Open
Abstract
Preprocedural planning and periprocedural guidance based on image fusion are widely established techniques supporting the interventional treatment of structural heart disease. However, these two techniques are typically used independently. Previous works have already demonstrated the benefits of integrating planning details into image fusion but are limited to a few applications and the availability of the proprietary tools used. We propose a vendor-independent approach to integrate planning details into periprocedural image fusion facilitating guidance during interventional treatment. In this work, we demonstrate the feasibility of integrating planning details derived from computer tomography and magnetic resonance imaging into periprocedural image fusion with open-source and commercially established tools. The integration of preprocedural planning details into periprocedural image fusion has the potential to support safe and efficient interventional treatment of structural heart disease.
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Ewert P, Eicken A, Tanase D, Georgiev S, Will A, Pankalla C, Nagdyman N, Meierhofer C, Hörer J. Transcatheter implantation of covered stents serving as extravascular conduits-Proof of a CT-based approach in three cases. Catheter Cardiovasc Interv 2022; 99:2054-2063. [PMID: 35395135 DOI: 10.1002/ccd.30190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Covered stents perform similar to surgically implanted conduits, although the stents work inside of vessels. We present a computed tomography (CT)-based workflow for the implantation of covered stents as extravascular conduits. METHODS We selected three different use cases: 1. Connecting a left-sided partially anomalous drainage of a pulmonary vein to the left atrium. 2. Bypassing an outgrown Dacron conduit in aortic recoarctation. 3. Re-directing hepatic venous blood to the left lung in a Fontan patient with heterotaxy, connecting the innominate vein to the right pulmonary artery like a right-sided cavopulmonary connection. By postprocessing and analyzing CT scans for planning and by the use of long needles under biplane fluoroscopy for the realization of the procedure, we projected and performed the exit of a long needle out of a vessel, the re-entering of a target vessel, and the bridging of the extravascular distance by implantation of covered stents. RESULTS In all three cases, the covered stents were placed successfully, connecting vessels of 15-50 mm distance from each other with very good hemodynamic results. In one case, two stents were placed consecutively, overlapping each other to accomplish an exact fitting at the connection sites to the native vessels.
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Affiliation(s)
- Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany.,Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Munich Heart Alliance, Munich, Germany
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Daniel Tanase
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Stanimir Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Albrecht Will
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Cornelia Pankalla
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nicole Nagdyman
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgerym, German Heart Center Munich, Technical University of Munich, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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Cohen S, Dohan A. Flow quantification in congenital heart disease with magnetic resonance imaging: A new tool in multimodality assessment of complex abnormalities. Arch Cardiovasc Dis 2020; 113:763-765. [PMID: 33308587 DOI: 10.1016/j.acvd.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/16/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah Cohen
- School of medicine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Pôle des cardiopathies congénitales de l'enfant et de l'adulte, Centre de référence des malformations cardiaques congénitales complexes (M3C), hôpital Marie Lannelongue, groupe hospitalier Paris Saint Joseph, 92350 Le Plessis-Robinson, France.
| | - Anthony Dohan
- Department of radiology, hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
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3D advanced imaging overlay with rapid registration in CHD to reduce radiation and assist cardiac catheterisation interventions. Cardiol Young 2020; 30:656-662. [PMID: 32290877 DOI: 10.1017/s1047951120000712] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Novel commercially available software has enabled registration of both CT and MRI images to rapidly fuse with X-ray fluoroscopic imaging. We describe our initial experience performing cardiac catheterisations with the guidance of 3D imaging overlay using the VesselNavigator system (Philips Healthcare, Best, NL). A total of 33 patients with CHD were included in our study. Demographic, advanced imaging, and catheterisation data were collected between 1 December, 2016 and 31 January, 2019. We report successful use of this technology in both diagnostic and interventional cases such as placing stents and percutaneous valves, performing angioplasties, occlusion of collaterals, and guidance for lymphatic interventions. In addition, radiation exposure was markedly decreased when comparing our 10-15-year-old coarctation of the aorta stent angioplasty cohort to cases without the use of overlay technology and the most recently published national radiation dose benchmarks. No complications were encountered due to the application of overlay technology. 3D CT or MRI overlay for CHD intervention with rapid registration is feasible and aids decisions regarding access and planned angiographic angles. Operators found intraprocedural overlay fusion registration using placed vessel guidewires to be more accurate than attempts using bony structures.
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