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Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model

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World Journal of Cardiology 2016年第10期8卷 606-614页

作者： verena veulemans Sabine Mollus Axel Saalbach Max Pietsch Katharina Hellhammer Tobias Zeus Ralf Westenfeld Jürgen Weese Malte Kelm Jan Balzer Department of Medicine Division of Cardiology Pulmonary Diseases Vascular Medicine University Hospital Düsseldorf Philips Research Europe Philips GmbH Innovative Technologies Research Laboratories

AIM To investigate the accuracy of a rotational C-arm CTbased 3D heart model to predict an optimal C-arm configuration during transcatheter aortic valve replacement(TAVR). METHODS Rotational C-arm CT(RCT) under rapid ventricular pacing was performed in 57 consecutive patients with severe aortic stenosis as part of the pre-procedural cardiac catheterization. With prototype software each RCT data set was segmented using a 3D heart model. From that the line of perpendicularity curve was obtained that generates a perpendicular view of the aortic annulus according to the right-cusp rule. To evaluate the accuracy of a model-based overlay we compared model- and expert-derived aortic root diameters. RESULTS For all 57 patients in the RCT cohort diameter measurements were obtained from two independent operators and were compared to the model-based measurements. The inter-observer variability was measured to be in the range of 0°-12.96° of angular C-arm displacement for two independent operators. The model-to-operator agreement was 0°-13.82°. The model-based and expert measurements of aortic root diameters evaluated at the aortic annulus(r = 0.79, P < 0.01), the aortic sinus(r = 0.93, P < 0.01) and the sino-tubular junction(r = 0.92, P < 0.01) correlated on a high level and the Bland-Altman analysis showed good agreement. The interobserver measurements did not show a significant bias. CONCLUSION Automatic segmentation of the aortic root using an anatomical model can accurately predict an optimal C-arm configuration, potentially simplifying current clinical workflows before and during TAVR.

关键词：大动脉的狭窄成像形式退化阀门疾病 Transcatheter 大动脉的阀门代替

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Initial clinical experience using the Echo Navigator~-system during structural heart disease interventions

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World Journal of Cardiology 2015年第9期7卷 562-570页

作者： Jan Balzer Tobias Zeus Katharina Hellhammer verena veulemans Silke Eschenhagen Eva Kehmeier Christian Meyer Tienush Rassaf Malte Kelm Division of Cardiology Pneumology and Angiology Department of Medicine University Hospital Duesseldorf

AIM: To present our initial clinical experience using this innovative software solution for guidance of percutaneous structural heart disease ***: Left atrial appendage, atrial septal defect and paravalvular leak closure, transaortic valve repair and Mitra Clip procedures were performed in the catheter laboratory under fluoroscopic and echocardiographic guidance. The two-dimensional and three-dimensional images generated by the transesophageal echocardiography probe were interfaced with the fluoroscopic images in real-time using the Echo Navigator-***:The application of the novel image fusion technology was safe and led to a better appreciation of multimodality imaging guidance due to improved visualization of the complex relationship between catheter devices and anatomical ***:The Echo Navigator-system is a feasible and safe tool for guidance of interventional procedures in structural heart *** innovative technology may improve confidence of interventional cardiologists in targeting and positioning interventional devices in order to increase safety,accuracy,and efficacy of percutaneous interventions in the catheter laboratory.

关键词： Fusion imaging Interventional guidance Percutaneou

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