Author + information
- Received March 23, 2011
- Revision received May 2, 2011
- Accepted May 25, 2011
- Published online December 13, 2011.
- Jörg Kempfert, MD⁎,
- Alois Noettling, PhD†,
- Matthias John, PhD†,
- Ardawan Rastan, MD, PhD⁎,
- Friedrich W. Mohr, MD, PhD⁎ and
- Thomas Walther, MD, PhD‡
The DynaCT system with prototype software (Siemens AG, Forchheim, Germany) allows for computed tomography-like imaging of the aortic root in the operative theater (hybrid suite) during transcatheter transapical aortic valve implantation. Image acquisition is performed by rotational angiography (200° in 5 s) with diluted contrast dye (25 ml total, injected at a rate of 15 ml/s). To minimize blood flow and motion, rapid ventricular pacing is performed (180 to 220 beats/min), and ventilation is stopped. The raw dataset is then automatically segmented, and specific landmarks—coronary ostia (blue = left; green = right) and the lowest point of each coronary sinus (red = nadir)—are automatically identified (A, Online Video 1). The red reference points are utilized to project a circle (yellow arrow) into the left ventricular outflow tract. A perfectly perpendicular angulation of the C-arm can be achieved when the circle becomes a straight line (B, yellow arrow, Online Video 2). Online overlay (C, yellow outline), which is automatically registered to the fluoroscopic images, allows for accurate image-guided aortic valve prosthesis implantation (Online Video 3, which demonstrates valve implantation: note the transesophageal echocardiography probe visible in the fluoroscopic image.)
Drs. Noettling and John are employees for Siemens AG. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 23, 2011.
- Revision received May 2, 2011.
- Accepted May 25, 2011.
- American College of Cardiology Foundation