Rivero-Ayerza Máximo, Jessurun Emil, Ramcharitar Steve, van Belle Yves, Serruys Patrick W, Jordaens Luc
Department of Clinical Electrophysiology, Thoraxcenter, Erasmus MC, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Europace. 2008 Sep;10(9):1042-7. doi: 10.1093/europace/eun173. Epub 2008 Jun 27.
Left ventricular (LV) lead implantation is feasible using remote magnetic navigation of a guidewire (Stereotaxis, St Louis, MO, USA). A novel software that performs a three-dimensional (3D) reconstruction of vessels based on two or more angiographic views has been developed recently (CardiOp-B system, Paeion Inc., Haifa, Israel). The objective of this paper is to evaluate: (i) the performance of the 3D reconstruction software which reproduce the anatomy of the coronary sinus (CS) and (ii) the efficacy of remotely navigating a magnetic guidewire within the CS based on this reconstruction.
In patients undergoing cardiac resynchronization therapy implantation, a 3D reconstruction of the CS was performed using the CardiOp-B system. Accuracy of the reconstruction was evaluated by comparing with the CS angiogram. This reconstruction was imported into the Stereotaxis system. On the basis of the reconstruction, magnetic vectors were automatically selected to navigate within the CS and manually adjusted if required. Feasibility of deploying the guidewire and LV lead into the selected side branch (SB), fluoroscopy time (FT) required for cannulation of the target SB, and total FT were also evaluated. Sixteen patients were included. In one case, the software could not reconstruct the CS. The quality of the reconstruction was graded as good in 13 and poor in 2. In 10 cases, manual adjustments to the traced edges of the CS were required to perform the 3D reconstruction, and in 5, no adjustments were required. In 13 patients, the target SB was engaged on the basis of the automatically selected vectors. In two cases, manual modification of the vector was required. Mean total FT was 23 +/- 14 min and the FT required to cannulate the target SB was 1.7 +/- 1.3 min.
A 3D reconstruction of the CS can be accurately performed using two angiographic views. This reconstruction allows precise magnetic navigation of a guidewire within the CS.
使用导丝的远程磁导航（美国密苏里州圣路易斯市的 Stereotaxis 公司）进行左心室（LV）导线植入是可行的。最近开发了一种基于两个或更多血管造影视图进行血管三维（3D）重建的新型软件（以色列海法市 Paeion 公司的 CardiOp - B 系统）。本文的目的是评估：（i）重现冠状窦（CS）解剖结构的 3D 重建软件的性能，以及（ii）基于此重建在 CS 内远程导航磁导丝的有效性。
在接受心脏再同步治疗植入的患者中，使用 CardiOp - B 系统对 CS 进行 3D 重建。通过与 CS 血管造影进行比较来评估重建的准确性。将此重建导入 Stereotaxis 系统。基于该重建，自动选择磁矢量以在 CS 内导航，并在需要时进行手动调整。还评估了将导丝和 LV 导线部署到选定侧支（SB）的可行性、插管目标 SB 所需的透视时间（FT）以及总 FT。纳入了 16 名患者。在 1 例中，软件无法重建 CS。重建质量评为良好的有 13 例，评为差的有 2 例。在 10 例中，进行 3D 重建需要对 CS 的追踪边缘进行手动调整，5 例则无需调整。在 13 名患者中，基于自动选择的矢量成功进入目标 SB。在 2 例中，需要对矢量进行手动修改。平均总 FT 为 23±14 分钟，插管目标 SB 所需的 FT 为 1.7±1.3 分钟。
使用两个血管造影视图可以准确地对 CS 进行 3D 重建。这种重建允许在 CS 内精确地对导丝进行磁导航。
