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A new approach of three-dimensional guidance in paediatric cath lab: segmented and tessellated heart models for cardiovascular interventions in CHD

Published online by Cambridge University Press:  18 January 2018

Nicole Ehret ,
Muhannad Alkassar ,
Sven Dittrich ,
Robert Cesnjevar ,
André Rüffer ,
Michael Uder ,
Oliver Rompel ,
Matthias Hammon  and
Martin Glöckler
Nicole Ehret*
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Muhannad Alkassar
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Sven Dittrich
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Robert Cesnjevar
Affiliation:
Department of Congenital Heart Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
André Rüffer
Affiliation:
Department of Congenital Heart Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Michael Uder
Affiliation:
Department of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Oliver Rompel
Affiliation:
Department of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Matthias Hammon
Affiliation:
Department of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
Martin Glöckler
Affiliation:
Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
*
Author for correspondence: N. Ehret, Department of Pediatric Cardiology, University Hospital Erlangen, Loschgestrasse 15, D-91054 Erlangen, Germany. Tel: +49 9131 8533750; Fax: +49 9131 8535987; E-mail: nicole.ehret@nefkom.net
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Abstract

Background

Optimal imaging is essential for catheter-based interventions in CHD. The three-dimensional models in volume-rendering technique currently in use are not standardised. This paper investigates the feasibility and impact of novel three-dimensional guidance with segmented and tessellated three-dimensional heart models in catheterisation of CHD. In addition, a nearly radiation-free two- to three-dimensional registration and a biplane overlay were used.

Methods and results

We analysed 60 consecutive cases in which segmented tessellated three-dimensional heart models were merged with live fluoroscopy images and aligned using the tracheal bifurcation as a fiducial mark. The models were generated from previous MRI or CT by dedicated medical software. We chose the stereo-lithography format, as this promises advantage over volume-rendering-technique models regarding visualisation. Prospects, potential benefits, and accuracy of the two- to three-dimensional registration were rated separately by two paediatric interventionalists on a five-point Likert scale. Fluoroscopy time, radiation dose, and contrast dye consumption were evaluated. Over a 10-month study period, two- to three-dimensional image fusion was applied to 60 out of 354 cases. Of the 60 catheterisations, 73.3% were performed in the context of interventions. The accuracy of two- to three-dimensional registration was sufficient in all cases. Three-dimensional guidance was rated superior to conventional biplane imaging in all 60 cases. We registered significantly smaller amounts of used contrast dye (p<0.01), lower levels of radiation dose (p<0.02), and less fluoroscopy time (p<0.01) during interventions concerning the aortic arch compared with a control group.

Conclusions

Two- to three-dimensional image fusion can be applied successfully in most catheter-based interventions of CHD. Meshes in stereo-lithography format are accurate and base for standardised and reproducible three-dimensional models.

Keywords

3D guidanceCHDcatheterisationTriangulated heart models
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 5 , May 2018 , pp. 661 - 667
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Copyright
© Cambridge University Press 2018 

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