Feasibility and Safety of Using a Fused Echocardiography/Fluoroscopy Imaging System in Patients with Congenital Heart Disease

• Published in: Journal of the American Society of Echocardiography Vol. 29; no. 6; pp. 513 - 521
• Main Authors: Jone, Pei-Ni, MD, Ross, Michael M., MD, MS, Bracken, John A., PhD, Mulvahill, Matthew J., MS, Di Maria, Michael V., MD, Fagan, Thomas E., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2016
• Subjects: Adolescent; Adult; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Cardiovascular; Cardiovascular Surgical Procedures - adverse effects; Cardiovascular Surgical Procedures - methods; Child; Child, Preschool; Congenital heart disease; Echocardiography, Three-Dimensional - adverse effects; Echocardiography, Three-Dimensional - methods; Echocardiography, Transesophageal - adverse effects; Echocardiography, Transesophageal - methods; EchoNavigator; Female; Fluoroscopy - adverse effects; Fluoroscopy - methods; Fused echocardiographic/fluoroscopic imaging; Fusion; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - surgery; Humans; Male; Multimodal Imaging - adverse effects; Multimodal Imaging - methods; Procedural guidance; Real-time 3D echocardiography; Treatment Outcome; Young Adult; RT; Real-time 3D echocardiography; Real-time; EchoNavigator; Two-dimensional; TViV; Congenital heart disease; Fused echocardiographic/x-ray fluoroscopic imaging; Procedural guidance; Tricuspid valve-in-valve; 3D; ASD; 2D; Three-dimensional; TEE; Atrial septal defect; FEX; Fused echocardiographic/fluoroscopic imaging; Fusion; CHD; Transesophageal echocardiographic
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2016.03.014

Background Fused real-time three-dimensional transesophageal echocardiography and fluoroscopy has been used in adult patients during percutaneous mitral valve and aortic valve procedures. The use of fused echocardiographic/x-ray fluoroscopic imaging (FEX) in pediatric patients undergoing congenital heart disease catheterization has not been evaluated for feasibility and safety. The aims of this study were to assess the feasibility and safety of FEX for interventional guidance and to perform a comparison of atrial septal defect (ASD) device closure using this technology with traditional guidance methods. Methods Prospective evaluation of FEX in congenital cardiac interventions was conducted. A subset of patients with ASD closures were compared with patients with historical ASD closures with and without FEX. The interventionalist and echocardiographer rated the anatomic quality of the fusion imaging as (1) excellent, (2) good, or (3) poor. In addition, the utility of FEX procedural guidance was graded as (1) superior, (2) no added benefit, or (3) inferior to that of standard guidance by fluoroscopy and transesophageal echocardiography. Results FEX was successfully used in 26 procedures on 25 patients with congenital heart disease from January 2013 to February 2015. The median age was 9 years (range, 3–26 years), and the median weight was 29 kg (range, 16–77 kg). Twenty-six procedures were performed, including ASD closure, Fontan fenestration closure, and transcatheter valve placement in the tricuspid valve position. There was reduced fluoroscopy time and radiation dose in patients with ASDs who underwent imaging using this new technology ( P  < .001 and P  < .03, respectively). There were no statistically significant differences in procedural times between the two groups. Anatomic definition was rated as excellent in 20 of 26 procedures, with the remaining six rated was good. Twenty-one of 26 procedures were graded as superior (81%), and five of 26 (19%) were graded as providing no added benefit. There were no complications in any of the procedures. Conclusions In this early experience, FEX is feasible and safe in patients undergoing congenital heart disease catheterization and provides useful guidance in the majority of interventional procedures. There were relative reductions in fluoroscopy time and radiation dose with the use of FEX for ASD closure.