Khaled Hadeed1, Sebastien Hascoët2, Clement Karsenty3, Miarisoa Ratsimandresy4, Yves Dulac4, Gerald Chausseray4, Xavier Alacoque4, Alain Fraisse5, Philippe Acar4. 1. Paediatric and Congenital Cardiology, Children's Hospital, M3C CHU Toulouse, Paul Sabatier University, 31059 Toulouse, France. Electronic address: hadeed.k@chu-toulouse.fr. 2. Paediatric and Congenital Cardiology, Children's Hospital, M3C CHU Toulouse, Paul Sabatier University, 31059 Toulouse, France; Department of Paediatric and Congenital Cardiac Surgery, M3C Marie-Lannelongue Hospital, Paris-Sud University, 92350 Le Plessis-Robinson, France. 3. Paediatric and Congenital Cardiology, Children's Hospital, M3C CHU Toulouse, Paul Sabatier University, 31059 Toulouse, France; Inserm UMR 1048, Équipe 8, institut des maladies métaboliques et cardiovasculaires (I2MC), Paul Sabatier University, 31432 Toulouse, France. 4. Paediatric and Congenital Cardiology, Children's Hospital, M3C CHU Toulouse, Paul Sabatier University, 31059 Toulouse, France. 5. Paediatric and Congenital Cardiology, Children's Hospital, M3C CHU Toulouse, Paul Sabatier University, 31059 Toulouse, France; Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College London, London SW3 6NP, UK.
Abstract
BACKGROUND: Transoesophageal echocardiography (TOE) has become indispensable in the catheterization laboratory in the guidance of some percutaneous interventions, as a complementary imaging technique to fluoroscopy. However, the two imaging modalities are presented separately and differently, making interpretation of the anatomical spatial relationships complicated. EchoNavigator® (Philips Healthcare, Best, the Netherlands) is an innovative software package, enabling fusion of fluoroscopic and echocardiographic images on the same screen. AIMS: To assess the feasibility of EchoNavigator® in the guidance of interventional procedures, and to present our initial clinical experience with this software. METHODS: Children with congenital heart disease who underwent interventional catheterization needing guidance with TOE from December 2015 to December 2017 were included. TOE was realized using a X7-2t TOE probe (Philips Healthcare) connected to an echocardiographic system (EPIC™; Philips Healthcare, Andover, MA). Fluoroscopy was realized using the Allura Xper FD/10 system (Philips Healthcare). Image fusion was attempted in all patients using EchoNavigator®. Markers were positioned on the target zone on echocardiographic images, and projected onto the merged screen. RESULTS: Fifty-one children were included (mean age, 8 years; mean weight, 25kg). Thirty-six patients underwent atrial septal defect closure, 10 ventricular septal defect closure, three aortic valve dilatation and two right ventricular outflow tract revalvulation. Image fusion was successfully obtained in all patients during all steps of the procedure. No complication related to the TOE probe was observed. Markers were successfully positioned in the all target zones, and were automatically projected onto the fusion screen. CONCLUSIONS: The EchoNavigator® system is feasible and safe in the guidance of interventional catheterization in children with congenital heart disease; it enables better appreciation of anatomical relationships and improves the confidence of the interventionist.
BACKGROUND: Transoesophageal echocardiography (TOE) has become indispensable in the catheterization laboratory in the guidance of some percutaneous interventions, as a complementary imaging technique to fluoroscopy. However, the two imaging modalities are presented separately and differently, making interpretation of the anatomical spatial relationships complicated. EchoNavigator® (Philips Healthcare, Best, the Netherlands) is an innovative software package, enabling fusion of fluoroscopic and echocardiographic images on the same screen. AIMS: To assess the feasibility of EchoNavigator® in the guidance of interventional procedures, and to present our initial clinical experience with this software. METHODS:Children with congenital heart disease who underwent interventional catheterization needing guidance with TOE from December 2015 to December 2017 were included. TOE was realized using a X7-2t TOE probe (Philips Healthcare) connected to an echocardiographic system (EPIC™; Philips Healthcare, Andover, MA). Fluoroscopy was realized using the Allura Xper FD/10 system (Philips Healthcare). Image fusion was attempted in all patients using EchoNavigator®. Markers were positioned on the target zone on echocardiographic images, and projected onto the merged screen. RESULTS: Fifty-one children were included (mean age, 8 years; mean weight, 25kg). Thirty-six patients underwent atrial septal defect closure, 10 ventricular septal defect closure, three aortic valve dilatation and two right ventricular outflow tract revalvulation. Image fusion was successfully obtained in all patients during all steps of the procedure. No complication related to the TOE probe was observed. Markers were successfully positioned in the all target zones, and were automatically projected onto the fusion screen. CONCLUSIONS: The EchoNavigator® system is feasible and safe in the guidance of interventional catheterization in children with congenital heart disease; it enables better appreciation of anatomical relationships and improves the confidence of the interventionist.
Authors: Elena K Grant; Joshua P Kanter; Laura J Olivieri; Russell R Cross; Adrienne Campbell-Washburn; Anthony Z Faranesh; Ileen Cronin; Karin S Hamann; Michael L O'Byrne; Michael C Slack; Robert J Lederman; Kanishka Ratnayaka Journal: Catheter Cardiovasc Interv Date: 2019-05-06 Impact factor: 2.692
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