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Biplane 3D overlay guidance for congenital heart disease to assist cardiac catheterization interventions-A pilot
Ravi V Vegulla1,2, Gerald Greil1, Surendranath V Reddy1
1Department of Pediatrics, Pediatric Cardiology, UT Southwestern Children's Medical Center, Dallas, TX, USA.
Insights
This study introduces an enhanced biplane system for congenital heart disease (CHD) catheterization, significantly reducing radiation and contrast agent use. The novel technology improved procedure guidance and operator preference in complex cases.
Area of Science:
- Medical Imaging
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Cardiac catheterization for congenital heart disease (CHD) traditionally uses fluoroscopy, posing risks from ionizing radiation and contrast agents.
- Existing fusion overlay techniques are limited to single planes, unlike the biplane fluoroscopy typically used for interventions.
- Patients often require multiple procedures, increasing cumulative radiation exposure and risks.
Purpose of the Study:
- To evaluate the initial experience and efficacy of an enhanced biplane GuideCCI system augmented by 3D modeling for CHD catheterization.
- To assess the impact of this novel technology on radiation and contrast agent utilization.
- To compare operator preference and procedural outcomes with traditional fluoroscopy.
Main Methods:
- Twenty-one pediatric and young adult patients with complex CHD underwent catheterization using the enhanced biplane GuideCCI system.
- 3D magnetic resonance imaging and computed tomography models were generated, overlaid, and displayed in real-time with biplane angiographs.
- Procedures included stent placements, balloon dilations, vessel occlusion, and percutaneous valve and pacemaker implantation.
Main Results:
- Successful implementation of the technology for 26 complex interventions without complications.
- Statistically significant reductions in radiation and contrast use were observed for specific procedures (coarctation stenting, pulmonary valve replacement) compared to benchmarks.
- Operators showed a preference for the augmented biplane system over traditional fluoroscopy for complex cardiac anatomy interventions.
Conclusions:
- The enhanced biplane GuideCCI system, augmented by 3D modeling, is a safe and effective tool for complex CHD catheterization.
- This technology offers a significant reduction in radiation and contrast agent exposure.
- Operator preference and successful procedural outcomes highlight its potential to improve patient care in interventional cardiology.
Abstract:
Cardiac catheterization for congenital heart disease (CHD) performed under fluoroscopic guidance still lacks definition and requires exposure to ionizing radiation and contrast agents, with most patients needing multiple procedures through their lifetime, leading to cumulative radiation risks. While fusion overlay techniques have been employed in the past to aid, these have been limited to a single plane, while interventions are traditionally performed under biplane fluoroscopy. We describe our initial experience performing cardiac catheterizations guided by an enhanced biplane GuideCCI system© (Siemens Healthcare, Germany) augmented by 3D magnetic resonance imaging and computed tomography modeling. Twenty-one children and young adults with CHD undergoing catheterization procedures between October 2019 and May 2021 were chosen based on their degree of complexity of cardiac anatomy. 3D stereolithography models were generated, overlayed, and displayed in real time, alongside angiographs in both planes on the screen during these procedures. We report successful implementation of this novel technology for performance of 26 interventions including stent placements, balloon dilations, vessel occlusion and percutaneous valve and transvenous pacemaker implantation all in patients with various complex cardiac anatomies. A statistically significant reduction in radiation and contrast use was noted for coarctation of the aorta stent angioplasty and transcatheter pulmonary valve replacement when compared with national benchmarks and local institutional metrics (with and without single plane overlay). No complications were encountered with the use of this technology. Use of a tracheal registration technique provided very good correlation in most cases. Operators preferred using biplane augmented catheterization over traditional fluoroscopy in patients with complex cardiac anatomy undergoing interventions.
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