Echonavigator in children with congenital heart diseases

Abstract

Transesophageal echocardiography (TEE) has become indispensable in catlab to guide some percutaneous interventions as a complimentary imaging for fluoroscopy. However the tow imaging modalities are presented separately and differently. Echonavigator® is an innovative software enabling fusion between the tow imaging modalities on the same screen. We aimed to assess the feasibility of Echonavigator system to guide interventional procedure in children with CHD, and to present our initial clinical experience using this software. We enrolled all children underwent interventional catheterization needing guidance by TEE from December 2015 to December 2017. Patients weighting less than 20 kg or having a contraindication for TEE were excluded. TEE was realized by using X7-2t TEE probe connected to an echocardiographic system (EPIC). Fluoroscopy was realized using Allura Xper FD/10 system. Image fusion was attempted in all patients using Echnavigator system. Markers were positioned on the target zone on echocardiographic images and projected to the interventionists on the fusing screen. Fifty-one patients with CHD were included, mean age was 8 years old (5.5–14), mean weight was 25 kg (20–36 kg). 36 patients underwent Atrial septal defect closure, 10 ventricular septal defect closure, 3 aortic valve dilatation and 2 right ventricular outflow tract revaluation. Image fusions were successfully obtained in all patients in real time during all steps of procedure. No complication related to TEE probe insertion or manipulation was observed. Markers were successfully positioned in the all target zones and automatically projected to the interventionist on the fusion screen. Echonavigator system is feasible and safe to guide interventional catheterization in children with CHD. It enables better appreciation of anatomical relationships and improves confidence of interventionist to achieve the target zones.