Alikhani Zoubin, Li Jonathan, Merchan Juan A, Nijhof Niels, Mendel Jeffrey, Orlov Michael V
St. Elizabeth's Medical Center of Boston, Tufts University School of Medicine, Boston, MA, USA.
J Interv Card Electrophysiol. 2013 Apr;36(3):217-22. doi: 10.1007/s10840-012-9736-8. Epub 2012 Nov 30.
This study aims to optimize coronary sinus (CS) computerized tomography (CT) imaging and evaluate its utility for preprocedural planning and intraoperative guidance by overlay of 3D reconstructed CS images on live fluoroscopy.
Optimal CS lead placement for cardiac resynchronization therapy (CRT) remains challenging. Preprocedural knowledge of CS anatomy can significantly affect procedural outcome. Optimal CS imaging protocols by CT have not been well defined.
Seventeen consecutive CRT recipients underwent contrast-enhanced functional cardiac CT on a 64-slice scanner. The CS target branch closest to the most dyssynchronous LV segment was identified. 3D volume rendered CS images were superimposed onto live fluoroscopy via EP Navigator (Philips Healthcare, Best, The Netherlands) to guide CS cannulation and lead placement. The imaging protocol was optimized.
CT images were successfully reconstructed and overlaid on live fluoroscopy in 16/17 patients. The overlay facilitated CS cannulation and lead placement into a predefined target branch. Excellent correlation between CT and angiographic CS anatomy was noted. By using the overlaid 3D CS as a road map, average total fluoroscopy time (14.56 ± 4.22 min) was significantly shorter when compared to historical controls. Total radiation exposure was significantly higher in the CT-guided group. Images obtained using double bolus injection and gated acquisition at 40 % of the cardiac cycle contained the most anatomical detail of the CS.
Overlay of 3D CS anatomy defined by preprocedural cardiac CT is feasible. It allows planning of CRT implantation and live guidance of CS lead placement into a predefined target branch. Limiting the CT imaging to 40 % of the cardiac cycle phase provides optimal CS images and reduces radiation exposure. This approach may result in shorter procedural time and more optimal CS lead positioning. However, the concept remains to be confirmed by future studies.
本研究旨在优化冠状窦（CS）计算机断层扫描（CT）成像，并通过将三维重建的CS图像叠加在实时荧光透视上，评估其在术前规划和术中引导方面的效用。
心脏再同步治疗（CRT）中CS电极的最佳放置仍然具有挑战性。术前对CS解剖结构的了解会显著影响手术结果。CT的最佳CS成像方案尚未明确界定。
17例连续的CRT接受者在64层扫描仪上接受了对比增强功能性心脏CT检查。确定最接近最不同步左心室节段的CS目标分支。通过EP Navigator（飞利浦医疗保健公司，荷兰贝斯特）将三维容积再现的CS图像叠加到实时荧光透视上，以指导CS插管和电极放置。对成像方案进行了优化。
16/17例患者的CT图像成功重建并叠加在实时荧光透视上。叠加有助于CS插管和将电极放置到预定义的目标分支中。注意到CT与血管造影CS解剖结构之间具有良好的相关性。通过将叠加的三维CS用作路线图，与历史对照组相比，平均总荧光透视时间（14.56±4.22分钟）显著缩短。CT引导组的总辐射暴露显著更高。使用双剂量注射并在心动周期的40%进行门控采集获得的图像包含CS的最详细解剖细节。
术前心脏CT定义的三维CS解剖结构叠加是可行的。它允许规划CRT植入，并在实时引导下将CS电极放置到预定义的目标分支中。将CT成像限制在心动周期的40%阶段可提供最佳的CS图像并减少辐射暴露。这种方法可能会缩短手术时间并实现更优化的CS电极定位。然而，这一概念仍有待未来研究证实。
