Accuracy of imaging fusion between echocardiography and fluoroscopy in percutaneous atrial septal defect closure in children

Abstract

Imaging fusion between echocardiography and fluoroscopy is now available in the catheterization laboratory. We aim to test the feasibility and accuracy of imaging fusion in a pediatric population. Thirty-one patients (26 kgs [21–37]) underwent percutaneous atrial septal defect (ASD) closure were prospectively included. Occluder device's screw, visualized on both echocardiography and fluoroscopy images was used as a reference tool. Bias was measured between a marker positioned on the device screw visualized on echocardiography and the fluoroscopic screw image on the fusion screen (distance 1). Another bias was measured between the screw on 3D echocardiographic image and the screw on fluoroscopic image (distance 2). The 2 distances were measured on 4 orthogonal views in end-systolic and end-diastolic frames. Fusion and marker positioning were feasible in real-time in all cases. In 5 cases (16.1%), there was a transient loss of the automatic tracking of the probe during the procedure. Quality of imaging fusion was rated good in all cases. On the fusion screen, systolic and diastolic first distances were 0.5 [0.3–1] and 2 mm [1.5–2.5] ( P < 0.0001). The marker positioned from echocardiography screen was fixed on fusion screen and did not follow the systole-diastolic translation of the screw. Systolic and diastolic second distances were 0.5 [0–0.5] and 2 mm [1.5–2.5] ( P < 0.0001). Echocardiographic-fluoroscopic imaging fusion is feasible, safe and accurate in children above 20 kgs. This innovate technic offers a new real-time imaging guiding modality in the catheterization laboratory with potential interest in complex procedures as well as for fellow training.