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Bodart LE, Ciske BR, Le J, Reilly NM, Deaño RC, Ewer SM, Tipnis P, Rahko PS, Wagner MG, Raval AN, Speidel MA. Technical and clinical study of x-ray-based surface echo probe tracking using an attached fiducial apparatus. Med Phys 2021; 48:2528-2542. [PMID: 33608930 DOI: 10.1002/mp.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Several types of structural heart intervention (SHI) use information from multiple imaging modalities to complete an interventional task. For example, in transcatheter aortic valve replacement (TAVR), placement and deployment of a bioprosthetic aortic valve in the aorta is primarily guided by x-ray fluoroscopy (XRF), and echocardiography provides visualization of cardiac anatomy and blood flow. However, simultaneous interpretation of independent x-ray and echo displays remains a challenge for the interventionalist. The purpose of this work was to develop a novel echo/x-ray co-registration solution in which volumetric transthoracic echo (TTE) is transformed to the x-ray coordinate system by tracking the three-dimensional (3D) pose of a probe fiducial attachment from its appearance in two-dimensional (2D) x-ray images. METHODS A fiducial attachment for a commercial TTE probe consisting of rings of high-contrast ball bearings was designed and fabricated. The 3D pose (position and orientation) of the fiducial attachment is estimated from a 2D x-ray image using an algorithm in which a virtual point cloud model of the attachment is iteratively rotated, translated, and forward-projected onto the image until the average sum-of-squares of grayscale values at the projected points is minimized. Fiducial registration error (FRE) and target registration error (TRE) of this approach were evaluated in phantom studies using TAVR-relevant gantry orientations and four standard acoustic windows for the TTE probe. A patient study was conducted to assess the clinical suitability of the fiducial attachment prototype during TTE imaging of patients undergoing SHI. TTE image quality for the task of guiding a transcatheter procedure was evaluated in a reviewer study. RESULTS The 3D FRE ranged from 0.32 ± 0.03 mm (mean ± SD) to 1.31 ± 0.05 mm, depending on C-arm orientation and probe acoustic window. The 3D TRE ranged from 1.06 ± 0.03 mm to 2.42 ± 0.06 mm. Fiducial pose estimation was stable when >75% of the fiducial markers were visible in the x-ray image. A panel of reviewers graded the presentation of heart valves in TTE images from 48 SHI patients. While valve presentation did not differ significantly between acoustic windows (P > 0.05), the mitral valve did achieve a significantly higher image quality compared to the aortic and tricuspid valves (P < 0.001). Overall, reviewers perceived sufficient image quality in 76.5% of images of the mitral valve, 54.9% of images of the aortic valve, and 48.6% of images of the tricuspid valve. CONCLUSIONS Fiducial-based tracking of a commercial TTE probe is compatible with clinical SHI workflows and yields 3D target registration error of less than 2.5 mm for a variety of x-ray gantry geometries and echo probe acoustic windows. Although TTE image quality with respect to target valve anatomy was sufficient for the majority of cases examined, prescreening of patients for sufficient TTE quality would be helpful.
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Affiliation(s)
- Lindsay E Bodart
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Benjamin R Ciske
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Jonathan Le
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Nicole M Reilly
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Roderick C Deaño
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Steven M Ewer
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Parag Tipnis
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Peter S Rahko
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Martin G Wagner
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Amish N Raval
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA.,Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
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2
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Wamala I, Unbehaun A, Klein C, Kukucka M, Eggert-Doktor D, Buz S, Stein J, Sündermann S, Falk V, Kempfert J. Real-time intraoperative co-registration of transesophageal echocardiography with fluoroscopy facilitates transcatheter mitral valve-in-valve implantation in cases of invisible degenerated bioprosthetic valves. Interact Cardiovasc Thorac Surg 2021; 32:695-702. [PMID: 33582775 DOI: 10.1093/icvts/ivab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/01/2020] [Accepted: 12/12/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Transcatheter mitral valve-in-valve (TMViV) implantation is an alternative treatment to surgery for high-risk patients with degenerated bioprosthetic mitral valves. Some types of bioprostheses are fluoroscopically translucent, resulting in an 'invisible' target deployment area. In this study, we describe the feasibility and outcomes of this procedure using intraoperative fusion of transoesophageal echocardiography (TEE) and live fluoroscopy to facilitate valve deployment in cases of invisible bioprosthetic valves. METHODS We reviewed all TMViV implantations at our centre from July 2014 to July 2019. Patient, procedure and outcome details were compared between those with a visible bioprosthesis (N = 22) to those with an invisible one (N = 12). Intra-operative TEE and live Fluoroscopy co-registration were used for real-time guidance for all invisible targets. RESULTS All valve implantations were completed successfully in both groups without cardiovascular injury, valve migration or left ventricular outflow-tract obstruction. Technical success was 100% in both groups. One-year survival was 83% [95% confidence interval (CI) 70-96] for the entire cohort, with 79% (95% CI 63-100) survival for the visible group and 92% (95% CI 77-100) for the invisible group. Probability of 1-year survival free from mitral valve reintervention, significant valve dysfunction, stroke or myocardial infraction was 78% (95% CI 63-93) for all patients whereby the probability was 72% (95% CI 54-97) in the visible group and 80% (95% CI 59-100) for the invisible group. CONCLUSIONS The use of intraoperative TEE and live fluoroscopy image fusion facilitates accurate TMViV among patients with a fluoroscopically invisible target-landing zone.
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Affiliation(s)
- Isaac Wamala
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Germany
| | - Christoph Klein
- Department of Internal Medicine, Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Marian Kukucka
- Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Germany
| | - Dirk Eggert-Doktor
- Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Germany
| | - Semih Buz
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Simon Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Germany.,Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Germany
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3
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Lai WT, Hsiung MC, Lin LC, Yin WH, Hsu CH, Huang KC. Stepwise manipulation of cardiac computed tomography multi-planar reconstruction to mimic transesophageal echocardiography. Echocardiography 2020; 37:1512-1523. [PMID: 32777107 DOI: 10.1111/echo.14801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/26/2022] Open
Abstract
Cardiac computed tomography (CT) is increasingly used to plan transcatheter structural heart interventions. However, intraoperative guidance relies on transesophageal echocardiography (TEE) and fluoroscopy. This study sought to develop a stepwise CT multi-planar reconstruction manipulation method to mimic TEE, bridging the gap between preoperative planning and intraoperative guidance tools. This CT manipulation reproduced similar configurations as TEE views in the mid-esophageal left ventricle (LV) views, transgastric LV 2-chamber views for mitral apparatus, and other miscellaneous views. Stepwise cardiac CT manipulation to mimic TEE is the final piece of the puzzle in the mental co-registration of these three crucial imaging modalities. Now, we can predict the TEE images and fluoroscopy projections in a preoperative rehearsal, thus improving the intraoperative accuracy of interventions.
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Affiliation(s)
- Wei-Tsung Lai
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | | | - Lung-Chun Lin
- Section of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | | | - Kuan-Chih Huang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Babić A, Odland HH, Lyseggen E, Holm T, Ross S, Hopp E, Haugaa KH, Kongsgård E, Edvardsen T, Gérard O, Samset E. An image fusion tool for echo-guided left ventricular lead placement in cardiac resynchronization therapy: Performance and workflow integration analysis. Echocardiography 2019; 36:1834-1845. [PMID: 31628770 DOI: 10.1111/echo.14483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/11/2019] [Accepted: 08/29/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The response rate to cardiac resynchronization therapy (CRT) may be improved if echocardiographic-derived parameters are used to guide the left ventricular (LV) lead deployment. Tools to visually integrate deformation imaging and fluoroscopy to take advantage of the combined information are lacking. METHODS An image fusion tool for echo-guided LV lead placement in CRT was developed. A personalized average 3D cardiac model aided visualization of patient-specific LV function in fluoroscopy. A set of coronary venography-derived landmarks facilitated registration of the 3D model with fluoroscopy into a single multimodality image. The fusion was both performed and analyzed retrospectively in 30 cases. Baseline time-to-peak values from echocardiography speckle-tracking radial strain traces were color-coded onto the fused LV. LV segments with suspected scar tissue were excluded by cardiac magnetic resonance imaging. The postoperative augmented image was used to investigate: (a) registration accuracy and (b) agreement between LV pacing lead location, echo-defined target segments, and CRT response. RESULTS Registration time (264 ± 25 seconds) and accuracy (4.3 ± 2.3 mm) were found clinically acceptable. A good agreement between pacing location and echo-suggested segments was found in 20 (out of 21) CRT responders. Perioperative integration of the proposed workflow was successfully tested in 2 patients. No additional radiation, compared with the existing workflow, was required. CONCLUSIONS The fusion tool facilitates understanding of the spatial relationship between the coronary veins and the LV function and may help targeted LV lead delivery.
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Affiliation(s)
- Aleksandar Babić
- Center for Cardiological Innovation, Oslo, Norway.,GE Vingmed Ultrasound, Horten, Norway.,University of Oslo, Oslo, Norway
| | - Hans Henrik Odland
- Center for Cardiological Innovation, Oslo, Norway.,University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Erik Lyseggen
- Center for Cardiological Innovation, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Holm
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Stian Ross
- Center for Cardiological Innovation, Oslo, Norway.,University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Einar Hopp
- Center for Cardiological Innovation, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristina H Haugaa
- Center for Cardiological Innovation, Oslo, Norway.,University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Erik Kongsgård
- Center for Cardiological Innovation, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- Center for Cardiological Innovation, Oslo, Norway.,University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Olivier Gérard
- Center for Cardiological Innovation, Oslo, Norway.,GE Vingmed Ultrasound, Horten, Norway
| | - Eigil Samset
- Center for Cardiological Innovation, Oslo, Norway.,GE Vingmed Ultrasound, Horten, Norway.,University of Oslo, Oslo, Norway
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Hadeed K, Hascoët S, Karsenty C, Ratsimandresy M, Dulac Y, Chausseray G, Alacoque X, Fraisse A, Acar P. Usefulness of echocardiographic-fluoroscopic fusion imaging in children with congenital heart disease. Arch Cardiovasc Dis 2018; 111:399-410. [DOI: 10.1016/j.acvd.2018.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/11/2018] [Accepted: 03/16/2018] [Indexed: 11/24/2022]
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6
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Wiley BM, Eleid MF, Thaden JJ. Técnicas de fusión de imagen en los procedimientos intervencionistas. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Vernikouskaya I, Rottbauer W, Gonska B, Rodewald C, Seeger J, Rasche V, Wöhrle J. Image-guidance for transcatheter aortic valve implantation (TAVI) and cerebral embolic protection. Int J Cardiol 2017; 249:90-95. [DOI: 10.1016/j.ijcard.2017.09.158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/26/2017] [Accepted: 09/15/2017] [Indexed: 11/25/2022]
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8
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Wiley BM, Eleid MF, Thaden JJ. Fusion Imaging for Procedural Guidance. ACTA ACUST UNITED AC 2017; 71:373-381. [PMID: 29191779 DOI: 10.1016/j.rec.2017.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/16/2017] [Indexed: 11/15/2022]
Abstract
The field of percutaneous structural heart interventions has grown tremendously in recent years. This growth has fueled the development of new imaging protocols and technologies in parallel to help facilitate these minimally-invasive procedures. Fusion imaging is an exciting new technology that combines the strength of 2 imaging modalities and has the potential to improve procedural planning and the safety of many commonly performed transcatheter procedures. In this review we discuss the basic concepts of fusion imaging along with the relative strengths and weaknesses of static vs dynamic fusion imaging modalities. This review will focus primarily on echocardiographic-fluoroscopic fusion imaging and its application in commonly performed transcatheter structural heart procedures.
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Affiliation(s)
- Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States.
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Zorinas A, Janusauskas V, Davidavicius G, Puodziukaite L, Zakarkaite D, Kramena R, Čypienė R, Bilkis V, Rucinskas K, Aidietis A, Onorato EM. Fusion of real-time 3D transesophageal echocardiography and cardiac fluoroscopy imaging in transapical catheter-based mitral paravalvular leak closure. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:263-268. [PMID: 29057000 PMCID: PMC5644046 DOI: 10.5114/aic.2017.70200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/17/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aleksejus Zorinas
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
| | - Vilius Janusauskas
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Lina Puodziukaite
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
| | - Diana Zakarkaite
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
| | - Rita Kramena
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Čypienė
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
| | - Valdas Bilkis
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
| | - Kestutis Rucinskas
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
| | - Audrius Aidietis
- Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
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Abstract
Arrhythmias are common in adults with congenital heart disease and account for a large proportion of hospitalizations. The complex anatomical heterogeneity, often in the presence of a delicate hemodynamic system, presents a significant electrophysiological challenge. This review outlines current clinical practice and advances in maximizing the effectiveness of ablation for arrhythmias in congenital heart patients.
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Thaden JJ, Sanon S, Geske JB, Eleid MF, Nijhof N, Malouf JF, Rihal CS, Bruce CJ. Echocardiographic and Fluoroscopic Fusion Imaging for Procedural Guidance: An Overview and Early Clinical Experience. J Am Soc Echocardiogr 2016; 29:503-12. [DOI: 10.1016/j.echo.2016.01.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Indexed: 10/22/2022]
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12
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Eskandari M, Dworakowski R, Byrne J, Wendler O, MacCarthy P, Monaghan M. Use of Fluoroscopy-Echocardiography Fusion Imaging in Transcatheter Aortic Valve Replacement. Echocardiography 2016; 33:1108-12. [PMID: 27095566 DOI: 10.1111/echo.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Bartel T, Müller S. Intraprocedural guidance: which imaging technique ranks highest and which one is complementary for closing paravalvular leaks? Cardiovasc Diagn Ther 2014; 4:277-8. [PMID: 25276612 DOI: 10.3978/j.issn.2223-3652.2014.08.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 07/24/2014] [Indexed: 11/14/2022]
Abstract
Echocardiographic guidance is critical for procedural success of paravalvular leak closure. Transesophageal echocardiography (TEE) and particularly three-dimensional echocardiography represent the gold standards. Fusion imaging provides real-time integration of three-dimensional echocardiography and X-ray fluoroscopy and can further facilitate spatial orientation, wire placement and device deployment. Intracardiac echocardiography (ICE) is a secondary approach possibly beneficial in selected cases.
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Affiliation(s)
- Thomas Bartel
- 1 Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates ; 2 Department of Internal Medicine III, Cardiology Division, Innsbruck Medical University, Austria
| | - Silvana Müller
- 1 Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates ; 2 Department of Internal Medicine III, Cardiology Division, Innsbruck Medical University, Austria
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