Vegulla Ravi V, Greil Gerald, Reddy Surendranath V, Zabala Luis, Dimas Vivian, Arar Yousef, Pontiki Antonia, Rhode Kawal, Hussain Tarique
Department of Pediatrics, Pediatric Cardiology, UT Southwestern Children's Medical Center, Dallas, TX, USA.
Pediatric Cardiology, Children's National Medical Center, Washington, DC, USA.
JRSM Cardiovasc Dis. 2024 Sep 19;13:20480040241274521. doi: 10.1177/20480040241274521. eCollection 2024 Jan-Dec.
Cardiac catheterization for congenital heart disease (CHD) performed under fluoroscopic guidance still lacks definition and requires exposure to ionizing radiation and contrast agents, with most patients needing multiple procedures through their lifetime, leading to cumulative radiation risks. While fusion overlay techniques have been employed in the past to aid, these have been limited to a single plane, while interventions are traditionally performed under biplane fluoroscopy. We describe our initial experience performing cardiac catheterizations guided by an enhanced biplane GuideCCI system (Siemens Healthcare, Germany) augmented by 3D magnetic resonance imaging and computed tomography modeling. Twenty-one children and young adults with CHD undergoing catheterization procedures between October 2019 and May 2021 were chosen based on their degree of complexity of cardiac anatomy. 3D stereolithography models were generated, overlayed, and displayed in real time, alongside angiographs in both planes on the screen during these procedures. We report successful implementation of this novel technology for performance of 26 interventions including stent placements, balloon dilations, vessel occlusion and percutaneous valve and transvenous pacemaker implantation all in patients with various complex cardiac anatomies. A statistically significant reduction in radiation and contrast use was noted for coarctation of the aorta stent angioplasty and transcatheter pulmonary valve replacement when compared with national benchmarks and local institutional metrics (with and without single plane overlay). No complications were encountered with the use of this technology. Use of a tracheal registration technique provided very good correlation in most cases. Operators preferred using biplane augmented catheterization over traditional fluoroscopy in patients with complex cardiac anatomy undergoing interventions.
在荧光透视引导下进行的先天性心脏病（CHD）心导管检查仍存在局限性，且需要暴露于电离辐射和造影剂中，大多数患者一生中需要进行多次手术，从而导致累积辐射风险。虽然过去曾采用融合叠加技术来辅助，但这些技术仅限于单一平面，而传统上干预操作是在双平面荧光透视下进行的。我们描述了我们最初使用增强型双平面GuideCCI系统（德国西门子医疗公司）进行心导管检查的经验，该系统通过三维磁共振成像和计算机断层扫描建模进行增强。根据心脏解剖结构的复杂程度，选择了2019年10月至2021年5月期间接受导管手术的21名患有CHD的儿童和青年。在这些手术过程中，生成、叠加并实时显示三维立体光刻模型，并与屏幕上两个平面的血管造影图像一起显示。我们报告了这项新技术在26项干预操作中的成功应用，包括支架置入、球囊扩张、血管闭塞以及经皮瓣膜和经静脉起搏器植入，所有这些操作均针对具有各种复杂心脏解剖结构的患者。与国家基准和当地机构指标（有和没有单平面叠加）相比，在主动脉缩窄支架血管成形术和经导管肺动脉瓣置换术中，辐射和造影剂的使用有统计学意义的减少。使用该技术未出现并发症。在大多数情况下，使用气管配准技术具有很好的相关性。在接受干预的具有复杂心脏解剖结构的患者中，操作人员更喜欢使用双平面增强导管检查而不是传统的荧光透视检查。
