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Traynor G, Shearn AIU, Milano EG, Ordonez MV, Velasco Forte MN, Caputo M, Schievano S, Mustard H, Wray J, Biglino G. The use of 3D-printed models in patient communication: a scoping review. J 3D Print Med 2022; 6:13-23. [PMID: 35211330 PMCID: PMC8852361 DOI: 10.2217/3dp-2021-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022]
Abstract
3D models have been used as an asset in many clinical applications and a variety of disciplines, and yet the available literature studying the use of 3D models in communication is limited. This scoping review has been conducted to draw conclusions on the current evidence and learn from previous studies, using this knowledge to inform future work. Our search strategy revealed 269 papers, 19 of which were selected for final inclusion and analysis. When assessing the use of 3D models in doctor-patient communication, there is a need for larger studies and studies including a long-term follow up. Furthermore, there are forms of communication that are yet to be researched and provide a niche that may be beneficial to explore.
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Affiliation(s)
- Gemma Traynor
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | - Andrew IU Shearn
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | - Elena G Milano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Silvia Schievano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6DD, UK
| | - Hannah Mustard
- University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- National Heart & Lung Institute, Imperial College London, London, SW3 6LY, UK
- Author for correspondence: Tel.: +44 117 342 3287;
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Sophocleous F, Bône A, Shearn AIU, Forte MNV, Bruse JL, Caputo M, Biglino G. Feasibility of a longitudinal statistical atlas model to study aortic growth in congenital heart disease. Comput Biol Med 2022; 144:105326. [PMID: 35245697 DOI: 10.1016/j.compbiomed.2022.105326] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 12/12/2022]
Abstract
Studying anatomical shape progression over time is of utmost importance to refine our understanding of clinically relevant processes. These include vascular remodeling, such as aortic dilation, which is particularly important in some congenital heart defects (CHD). A novel methodological framework for three-dimensional shape analysis has been applied for the first time in a CHD scenario, i.e., bicuspid aortic valve (BAV) disease, the most common CHD. Three-dimensional aortic shapes (n = 94) reconstructed from cardiovascular magnetic resonance imaging (MRI) data as surface meshes represented the input for a longitudinal atlas model, using multiple scans over time (n = 2-4 per patient). This model relies on diffeomorphism transformations in the absence of point-to-point correspondence, and on the right combination of initialization, estimation and registration parameters. We computed the shape trajectory of an average disease progression in our cohort, as well as time-dependent parameters, geometric variations and the average shape of the population. Results cover a spatiotemporal spectrum of visual and numerical information that can be further used to run clinical associations. This proof-of-concept study demonstrates the feasibility of applying advanced statistical shape models to track disease progression and stratify patients with CHD.
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Affiliation(s)
- Froso Sophocleous
- Bristol Medical School, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Alexandre Bône
- ARAMIS Lab, ICM, Inserm U1127, CNRS UMR 7225, Sorbonne University, Inria, Paris, France
| | - Andrew I U Shearn
- Bristol Medical School, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | | | - Jan L Bruse
- Vicomtech Foundation, Basque Research and Technology Alliance BRTA, Mikeletegi 57, 20009, Donostia-San Sebastián, Spain
| | - Massimo Caputo
- Bristol Medical School, Faculty of Life Sciences, University of Bristol, Bristol, UK; Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Medical School, Faculty of Life Sciences, University of Bristol, Bristol, UK; Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; National Heart and Lung Institute, Imperial College London, London, UK.
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Gómez-Ciriza G, Gómez-Cía T, Rivas-González JA, Velasco Forte MN, Valverde I. Affordable Three-Dimensional Printed Heart Models. Front Cardiovasc Med 2021; 8:642011. [PMID: 34150862 PMCID: PMC8211988 DOI: 10.3389/fcvm.2021.642011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/29/2021] [Indexed: 12/24/2022] Open
Abstract
This is a 7-years single institution study on low-cost cardiac three-dimensional (3D) printing based on the use of free open-source programs and affordable printers and materials. The process of 3D printing is based on several steps (image acquisition, segmentation, mesh optimization, slicing, and three-dimensional printing). The necessary technology and the processes to set up an affordable three-dimensional printing laboratory are hereby described in detail. Their impact on surgical and interventional planning, medical training, communication with patients and relatives, patients' perception on care, and new cardiac device development was analyzed. A total of 138 low-cost heart models were designed and printed from 2013 to 2020. All of them were from different congenital heart disease patients. The average time for segmentation and design of the hearts was 136 min; the average time for printing and cleaning the models was 13.5 h. The average production cost of the models was €85.7 per model. This is the most extensive series of 3D printed cardiac models published to date. In this study, the possibility of manufacturing three-dimensional printed heart models in a low-cost facility fulfilling the highest requirements from a technical and clinical point of view is demonstrated.
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Affiliation(s)
- Gorka Gómez-Ciriza
- Fabrication Laboratory, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (IBIS), Seville, Spain
| | - Tomás Gómez-Cía
- Fabrication Laboratory, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (IBIS), Seville, Spain.,Plastic Surgery and Burns Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - José Antonio Rivas-González
- Fabrication Laboratory, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville (IBIS), Seville, Spain
| | - Mari Nieves Velasco Forte
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom
| | - Israel Valverde
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom.,Cardiovascular Pathology Unit, Institute of Biomedicine of Seville (IBIS), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Hospital Virgen de Rocio/Consejo Superior de Investigaciones Científicas/University of Seville, Seville, Spain.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Velasco Forte MN, Roujol S, Ruijsink B, Valverde I, Duong P, Byrne N, Krueger S, Weiss S, Arar Y, Reddy SRV, Schaeffter T, Hussain T, Razavi R, Pushparajah K. MRI for Guided Right and Left Heart Cardiac Catheterization: A Prospective Study in Congenital Heart Disease. J Magn Reson Imaging 2021; 53:1446-1457. [PMID: 33155758 PMCID: PMC8247035 DOI: 10.1002/jmri.27426] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Improvements in outcomes for patients with congenital heart disease (CHD) have increased the need for diagnostic and interventional procedures. Cumulative radiation risk is a growing concern. MRI-guided interventions are a promising ionizing radiation-free, alternative approach. PURPOSE To assess the feasibility of MRI-guided catheterization in young patients with CHD using advanced visualization passive tracking techniques. STUDY TYPE Prospective. POPULATION A total of 30 patients with CHD referred for MRI-guided catheterization and pulmonary vascular resistance analysis (median age/weight: 4 years / 15 kg). FIELD STRENGTH/SEQUENCE 1.5T; partially saturated (pSAT) real-time single-shot balanced steady-state free-precession (bSSFP) sequence. ASSESSMENT Images were visualized by a single viewer on the scanner console (interactive mode) or using a commercially available advanced visualization platform (iSuite, Philips). Image quality for anatomy and catheter visualization was evaluated by three cardiologists with >5 years' experience in MRI-catheterization using a 1-5 scale (1, poor, 5, excellent). Catheter balloon signal-to-noise ratio (SNR), blood and myocardium SNR, catheter balloon/blood contrast-to-noise ratio (CNR), balloon/myocardium CNR, and blood/myocardium CNR were measured. Procedure findings, feasibility, and adverse events were recorded. A fraction of time in which the catheter was visible was compared between iSuite and the interactive mode. STATISTICAL TESTS T-test for numerical variables. Wilcoxon signed rank test for categorical variables. RESULTS Nine patients had right heart catheterization, 11 had both left and right heart catheterization, and 10 had single ventricle circulation. Nine patients underwent solely MRI-guided catheterization. The mean score for anatomical visualization and contrast between balloon tip and soft tissue was 3.9 ± 0.9 and 4.5 ± 0.7, respectively. iSuite provided a significant improvement in the time during which the balloon was visible in relation to interactive imaging mode (66 ± 17% vs. 46 ± 14%, P < 0.05). DATA CONCLUSION MRI-guided catheterizations were carried out safely and is feasible in children and adults with CHD. The pSAT sequence offered robust and simultaneous high contrast visualization of the catheter and cardiac anatomy. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Mari Nieves Velasco Forte
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
- Cardiovascular Pathology UnitInstitute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of SevilleSevilleSpain
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Bram Ruijsink
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Israel Valverde
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
- Cardiovascular Pathology UnitInstitute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of SevilleSevilleSpain
| | - Phuoc Duong
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Nick Byrne
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Medical PhysicsGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | | | | | - Yousef Arar
- Department of PediatricsUT Southwestern Medical CenterDallasTexasUSA
| | | | - Tobias Schaeffter
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Tarique Hussain
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of PediatricsUT Southwestern Medical CenterDallasTexasUSA
| | - Reza Razavi
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
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Veeram Reddy SR, Arar Y, Zahr RA, Gooty V, Hernandez J, Potersnak A, Douglas P, Blair Z, Greer JS, Roujol S, Forte MNV, Greil G, Nugent AW, Hussain T. Invasive cardiovascular magnetic resonance (iCMR) for diagnostic right and left heart catheterization using an MR-conditional guidewire and passive visualization in congenital heart disease. J Cardiovasc Magn Reson 2020; 22:20. [PMID: 32213193 PMCID: PMC7098096 DOI: 10.1186/s12968-020-0605-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Today's standard of care, in the congenital heart disease (CHD) population, involves performing cardiac catheterization under x-ray fluoroscopy and cardiac magnetic resonance (CMR) imaging separately. The unique ability of CMR to provide real-time functional imaging in multiple views without ionizing radiation exposure has the potential to be a powerful tool for diagnostic and interventional procedures. Limiting fluoroscopic radiation exposure remains a challenge for pediatric interventional cardiologists. This pilot study's objective is to establish feasibility of right (RHC) and left heart catheterization (LHC) during invasive CMR (iCMR) procedures at our institution in the CHD population. Furthermore, we aim to improve simultaneous visualization of the catheter balloon tip, MR-conditional guidewire, and cardiac/vessel anatomy during iCMR procedures. METHODS Subjects with CHD were enrolled in a pilot study for iCMR procedures at 1.5 T with an MR-conditional guidewire. The CMR area is located adjacent to a standard catheterization laboratory. Using the interactive scanning mode for real-time control of the imaging location, a dilute gadolinium-filled balloon-tip catheter was used in combination with an MR-conditional guidewire to obtain cardiac saturations and hemodynamics. A recently developed catheter tracking technique using a real-time single-shot balanced steady-state free precession (bSSFP), flip angle (FA) 35-45°, echo time (TE) 1.3 ms, repetition time (TR) 2.7 ms, 40° partial saturation (pSAT) pre-pulse was used to visualize the gadolinium-filled balloon, MR-conditional guidewire, and cardiac structures simultaneously. MR-conditional guidewire visualization was enabled due to susceptibility artifact created by distal markers. Pre-clinical phantom testing was performed to determine the optimum imaging FA-pSAT combination. RESULTS The iCMR procedure was successfully performed to completion in 31/34 (91%) subjects between August 1st, 2017 to December 13th, 2018. Median age and weight were 7.7 years and 25.2 kg (range: 3 months - 33 years and 8 - 80 kg). Twenty-one subjects had single ventricle (SV) anatomy: one subject was referred for pre-Glenn evaluation, 11 were pre-Fontan evaluations and 9 post-Fontan evaluations for protein losing enteropathy (PLE) and/or cyanosis. Thirteen subjects had bi-ventricular (BiV) anatomy, 4 were referred for coarctation of the aorta (CoA) evaluations, 3 underwent vaso-reactivity testing with inhaled nitric oxide, 3 investigated RV volume dimensions, two underwent branch PA stenosis evaluation, and the remaining subject was status post heart transplant. No catheter related complications were encountered. Average time taken for first pass RHC, LHC/aortic pull back, and to cross the Fontan fenestration was 5.2, 3.0, and 6.5 min, respectively. Total success rate to obtain required data points to complete Fick principle calculations for all patients was 331/337 (98%). Subjects were transferred to the x-ray fluoroscopy lab if further intervention was required including Fontan fenestration device closure, balloon angioplasty of pulmonary arteries/conduits, CoA stenting, and/or coiling of aortopulmonary (AP) collaterals. Starting with subject #10, an MR-conditional guidewire was used in all subsequent subjects (15 SV and 10 BiV) with a success rate of 96% (24/25). Real-time CMR-guided RHC (25/25 subjects, 100%), retrograde and prograde LHC/aortic pull back (24/25 subjects, 96%), CoA crossing (3/4 subjects, 75%) and Fontan fenestration test occlusion (2/3 subjects, 67%) were successfully performed in the majority of subjects when an MR-conditional guidewire was utilized. CONCLUSION Feasibility for detailed diagnostic RHC, LHC, and Fontan fenestration test occlusion iCMR procedures in SV and BiV pediatric subjects with complex CHD is demonstrated with the aid of an MR-conditional guidewire. A novel real-time pSAT GRE sequence with optimized FA-pSAT angle has facilitated simultaneous visualization of the catheter balloon tip, MR-conditional guidewire, and cardiac/vessel anatomy during iCMR procedures.
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Affiliation(s)
- Surendranath R. Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Jennifer Hernandez
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
| | - Amanda Potersnak
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Phillip Douglas
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Zachary Blair
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Joshua S. Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Sébastien Roujol
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Mari Nieves Velasco Forte
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Alan W. Nugent
- Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611 USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
- Pediatric Cardiology, Children’s Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235 USA
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
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Riahi M, Velasco Forte MN, Byrne N, Hermuzi A, Jones M, Baruteau AE, Valverde I, Qureshi SA, Rosenthal E. Early experience of transcatheter correction of superior sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage. EUROINTERVENTION 2019; 14:868-876. [PMID: 30012542 DOI: 10.4244/eij-d-18-00304] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Superior sinus venosus atrial septal defect (SVASD) is commonly associated with partial anomalous pulmonary venous drainage (PAPVD). We aimed to describe the first series of percutaneous SVASD and PAPVD correction using a two-step simulation for procedural planning. METHODS AND RESULTS Patients with SVASD and right PAPVD with a clinical indication for correction were selected. They underwent an ex vivo procedural simulation on a 3D-printed model followed by an in vivo simulation using balloon inflation in the targeted stent landing zone. The percutaneous procedure consisted in deploying a 10-zig custom-made covered stent in the SVC-RA junction. Five patients were referred for preprocedural evaluation and were deemed suitable for percutaneous correction. The procedure was successful in all patients with no residual interatrial shunt and successful redirection of the pulmonary venous drainage to the left atrium. At a median clinical follow-up of 8.1 months (2.6-19.8), no adverse events were noted, and all patients showed clinical improvement. During follow-up, transthoracic echocardiography and multidetector cardiac tomography in four patients or invasive angiography in one patient demonstrated a patent SVC stent, and no residual SVASD and unobstructed PV drainage in all patients. CONCLUSIONS In selected patients using a two-stage simulation strategy, percutaneous correction of SVASD with PAPVD is feasible and safe, and led to favourable short-term outcomes.
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Affiliation(s)
- Mounir Riahi
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Tandon A, Burkhardt BE, Batsis M, Zellers TM, Velasco Forte MN, Valverde I, McMahan RP, Guleserian KJ, Greil GF, Hussain T. Sinus Venosus Defects. JACC Cardiovasc Imaging 2019; 12:921-924. [DOI: 10.1016/j.jcmg.2018.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 11/16/2022]
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Velasco Forte MN, Valverde I, Prabhu N, Correia T, Narayan SA, Bell A, Mathur S, Razavi R, Hussain T, Pushparajah K, Henningsson M. Visualization of coronary arteries in paediatric patients using whole-heart coronary magnetic resonance angiography: comparison of image-navigation and the standard approach for respiratory motion compensation. J Cardiovasc Magn Reson 2019; 21:13. [PMID: 30798789 PMCID: PMC6388473 DOI: 10.1186/s12968-019-0525-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Abstract
AIMS To investigate the use of respiratory motion compensation using image-based navigation (iNAV) with constant respiratory efficiency using single end-expiratory thresholding (CRUISE) for coronary magnetic resonance angiography (CMRA), and compare it to the conventional diaphragmatic navigator (dNAV) in paediatric patients with congenital or suspected heart disease. METHODS iNAV allowed direct tracking of the respiratory heart motion and was generated using balanced steady state free precession startup echoes. Respiratory gating was achieved using CRUISE with a fixed 50% efficiency. Whole-heart CMRA was acquired with 1.3 mm isotropic resolution. For comparison, CMRA with identical imaging parameters were acquired using dNAV. Scan time, visualization of coronary artery origins and mid-course, imaging quality and sharpness was compared between the two sequences. RESULTS Forty patients (13 females; median weight: 44 kg; median age: 12.6, range: 3 months-17 years) were enrolled. 25 scans were performed in awake patients. A contrast agent was used in 22 patients. The scan time was significantly reduced using iNAV for awake patients (iNAV 7:48 ± 1:26 vs dNAV 9:48 ± 3:11, P = 0.01) but not for patients under general anaesthesia (iNAV = 6:55 ± 1:50 versus dNAV = 6:32 ± 2:16; P = 0.32). In 98% of the cases, iNAV image quality had an equal or higher score than dNAV. The visual score analysis showed a clear difference, favouring iNAV (P = 0.002). The right coronary artery and the left anterior descending vessel sharpness was significantly improved (iNAV: 56.8% ± 10.1% vs dNAV: 53.7% ± 9.9%, P < 0.002 and iNAV: 55.8% ± 8.6% vs dNAV: 53% ± 9.2%, P = 0.001, respectively). CONCLUSION iNAV allows for a higher success-rate and clearer depiction of the mid-course of coronary arteries in paediatric patients. Its acquisition time is shorter in awake patients and image quality score is equal or superior to the conventional method in most cases.
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Affiliation(s)
- Mari Nieves Velasco Forte
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Israel Valverde
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Nanda Prabhu
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Teresa Correia
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Srinivas Ananth Narayan
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Aaron Bell
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Sujeev Mathur
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Reza Razavi
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Tarique Hussain
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, USA
| | - Kuberan Pushparajah
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Markus Henningsson
- Division of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Velasco Forte MN, Byrne N, Valverde Perez I, Bell A, Gómez-Ciriza G, Krasemann T, Sievert H, Simpson J, Pushparajah K, Razavi R, Qureshi S, Hussain T. 3D printed models in patients with coronary artery fistulae: anatomical assessment and interventional planning. EUROINTERVENTION 2018; 13:e1080-e1083. [PMID: 28555593 DOI: 10.4244/eij-d-16-00897] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Coronary artery fistulae represent one of the most challenging anatomical defects to define accurately. We aimed to investigate the additional benefit conferred by volume rendering of tomographic images and 3D printing for diagnosis and interventional planning. METHODS AND RESULTS Four cases of coronary fistulae were considered for transcatheter closure. Multidetector computed tomography (three cases) or cardiac magnetic resonance (one case) images were acquired and segmented using Mimics software. Each case was reviewed after incremental consideration of diagnostic resources: two cardiologists reported source and volume-rendered images; device closure was discussed by the interventional cardiology team. All diagnoses and planned management were reviewed after inspection of a 3D model. Using source images alone, both cardiologists correctly described the course and drainage in two out of four cases. Aided by volume rendering, this improved to three out of four cases. Inspection of the 3D printed model prompted the planned interventional approach and device sizing to be altered in two out of four cases. In one out of four cases, the intervention was abandoned after inspection of the 3D printed model. CONCLUSIONS Diagnosis and management of patients with coronary artery fistulae rely on detailed image analyses. 3D models add value when determining the feasibility of, and the approach to intervention in these cases.
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Affiliation(s)
- Mari Nieves Velasco Forte
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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Velasco Forte MN, Byrne N, Valverde I, Gomez Ciriza G, Hermuzi A, Prachasilchai P, Mainzer G, Pushparajah K, Henningsson M, Hussain T, Qureshi S, Rosenthal E. Interventional Correction of Sinus Venosus Atrial Septal Defect and Partial Anomalous Pulmonary Venous Drainage. JACC Cardiovasc Imaging 2018; 11:275-278. [DOI: 10.1016/j.jcmg.2017.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/05/2017] [Accepted: 07/07/2017] [Indexed: 11/30/2022]
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Velasco Forte MN, Pushparajah K, Schaeffter T, Valverde Perez I, Rhode K, Ruijsink B, Alhrishy M, Byrne N, Chiribiri A, Ismail T, Hussain T, Razavi R, Roujol S. Improved passive catheter tracking with positive contrast for CMR-guided cardiac catheterization using partial saturation (pSAT). J Cardiovasc Magn Reson 2017; 19:60. [PMID: 28806996 PMCID: PMC5556659 DOI: 10.1186/s12968-017-0368-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiac catheterization is a common procedure in patients with congenital heart disease (CHD). Although cardiovascular magnetic resonance imaging (CMR) represents a promising alternative approach to fluoroscopy guidance, simultaneous high contrast visualization of catheter, soft tissue and the blood pool remains challenging. In this study, a novel passive tracking technique is proposed for enhanced positive contrast visualization of gadolinium-filled balloon catheters using partial saturation (pSAT) magnetization preparation. METHODS The proposed pSAT sequence uses a single shot acquisition with balanced steady-state free precession (bSSFP) readout preceded by a partial saturation pre-pulse. This technique was initially evaluated in five healthy subjects. The pSAT sequence was compared to conventional bSSFP images acquired with (SAT) and without (Non-SAT) saturation pre-pulse. Signal-to-noise ratio (SNR) of the catheter balloon, blood and myocardium and the corresponding contrast-to-noise ratio (CNR) are reported. Subjective assessment of image suitability for CMR-guidance and ideal pSAT angle was performed by three cardiologists. The feasibility of the pSAT sequence is demonstrated in two adult patients undergoing CMR-guided cardiac catheterization. RESULTS The proposed pSAT approach provided better catheter balloon/blood contrast and catheter balloon/myocardium contrast than conventional Non-SAT sequences. It also resulted in better blood and myocardium SNR than SAT sequences. When averaged over all volunteers, images acquired with a pSAT angle of 20° to 40° enabled simultaneous visualization of the catheter balloon and the cardiovascular anatomy (blood and myocardium) and were found suitable for CMR-guidance in >93% of cases. The pSAT sequence was successfully used in two patients undergoing CMR-guided diagnostic cardiac catheterization. CONCLUSIONS The proposed pSAT sequence offers real-time, simultaneous, enhanced contrast visualization of the catheter balloon, soft tissues and blood. This technique provides improved passive tracking capabilities during CMR-guided catheterization in patients.
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Affiliation(s)
- Mari Nieves Velasco Forte
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Medical Physics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Israel Valverde Perez
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Kawal Rhode
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Bram Ruijsink
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Mazen Alhrishy
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Nicholas Byrne
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Tevfik Ismail
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Dept. of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, USA
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sébastien Roujol
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
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