Feasibility, Safety and Accuracy of Echocardiography-Fluoroscopy Imaging Fusion During Percutaneous Atrial Septal Defect Closure in Children

Abstract

Imaging fusion between echocardiography and fluoroscopy was recently developed. The aim of this study was to assess its feasibility and accuracy during pediatric cardiac catheterization. Thirty-one patients (median weight, 26kg; interquartile range [IQR], 21-37kg) who underwent percutaneous atrial septal defect closure were prospectively included. The feasibility and accuracy of various imaging fusion modalities (live two-dimensional, live color two-dimensional, live three-dimensional and markers) with EchoNavigator software were assessed. To assess the accuracy of spatial registration of the echocardiogram on the fluoroscopic image, the occluder screw, an object that appeared on each image, was used as a reference tool, and the distance between the two when fused was measured. A distance was measured on the fusion screen between a marker positioned on the screw from the echocardiography screen and from the fluoroscopy screen (distance 1). Another distance was measured on the fusion screen between the screw visualized by three-dimensional echocardiography and by fluoroscopy (distance 2). The two distances were measured on four C-arm orientations in end-systolic and end-diastolic frames. Fusion and marker positioning were feasible in real time in all cases. On the fusion screen, median systolic and diastolic distance 1 were 0.5mm (IQR, 0.3-1mm) and 2mm (IQR, 1.5-2.5mm; P<.0001), respectively. The marker positioned from the echocardiography screen was fixed on the fusion screen anddid not follow the movement of the screw. Median systolic and diastolic distance 2 were 0.5mm (IQR, 0-0.5mm) and 2mm (IQR, 1.5-2.5mm; P<.0001), respectively. Echocardiographic fluoroscopic imaging fusion is feasible, safe, and accurate in children weighting >20kg. This technique offers a new method of imaging guidance in the catheterization laboratory for complex procedures and training.