Echonavigator® in children with congenital heart diseases

Abstract

Transesophageal echocardiography (TEE) has become indispensable in cat-lab to guide some percutaneous interventions as a complimentary imaging for fluoroscopy. However, the tow imaging modalities are presented separately and differently making the interpretation of the anatomic spatial relationships not easy. Echonavigator ® (Philips Healthcare, Best, The Netherlands) is an innovative software enabling fusion between fluoroscopic and echocardiographic image on the same screen. Few data on its feasibility and its clinical applications in children with congenital heart diseases (CHD) are currently available. 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 for guidance of percutaneous treatment of children with CHD. 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 a pediatric cardiologist using X7-2t TEE probe connected to an echocardiographic system (EPIC). Fluoroscopy was realized by interventional cardiologist using Allura Xper FD/10 system (Philips Healthcare). 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 ( Fig. 1 ). 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.