Author + information
- Akanksha Thakkar,
- Ponraj Chinnadurai,
- Basel Ramlawi,
- John Breinholt,
- Gary Monteiro,
- Alan Lumsden and
- C. Huie Lin
Background: CT image fusion enhances fluoroscopy during structural heart interventions. We present a case series to demonstrate the techniques and utility of CTA-fluoroscopy image fusion during percutaneous pulmonary valve implantation (PPVI).
Methods: Retrospective review of patients from Dec 2014 – Aug 2016 who underwent PPVI under image fusion guidance was performed. Fluoroscopy time, radiation exposure and number of angiograms were noted. Image fusion was performed using two techniques: (a) 3D3D by aligning CTA with on-table cone-beam CT (b) 2D3D by aligning bony landmarks and sternal wires from CTA with two fluoroscopy images acquired at-least 30-degrees apart. After image fusion, relevant 3D landmarks from CTA were overlaid on fluoroscopy.
Results: Four patients underwent PPVI with Melody® valve during the study period under image fusion guidance. CTA image fusion helped with optimizing C-arm working projection and real-time overlay of 3D landmarks helped during device deployment. On comparing 3D3D vs 2D3D techniques, median fluoroscopy time was 27.5 vs 57.1 minutes, dose-area-product was 46229 vs 70979 microGym2, skin dose was 2023 vs 630 mGy and median number of cine acquisitions was 3 vs 10.
Conclusions: CTA-fluoroscopy image fusion offers additional image guidance especially in complex PPVI. Based on our preliminary experience, we believe that such multi-modality image fusion has the potential to improve safety and efficacy of PPVI. This needs further validation.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: Angiography, Intravascular Imaging and Interventional CT/MR
Abstract Category: 16. Interventional Cardiology: Angiography and Interventional CT/MR
Presentation Number: 1153-124
- 2017 American College of Cardiology Foundation