Fusion between 3D transthoracic echocardiography and computed cardiac tomography: A novel diagnostic approach in congenital heart disease

Abstract

Cardiac ultrasound has remained the primary tool for diagnostic and surgical decision-making for congenital heart disease (CHD). With recent developments in fusion imaging especially between CT and 3D echocardiography, previously described in percutaneous tricuspid annuloplasty and left atrial appendage closure, we obtain more information from combined images. Our aim is to study the feasibility and the added preoperative input and educational value of CT/3D-US fusion in prospective cohort of CHD patients more specifically in double outlet right ventricle, where a biventricular repair approach may need delicate preoperative analysis in order to achieve the best result. We prospectively included 25 patients (median age: 5 years) with mild to complex CHD, who underwent cardiac CT and 3D transthoracic echocardiography as part of their pre-operative or follow-up evaluation at our centre. We included three complete atrioventricular canal, three transposition of the great arteries, two congenitally corrected transposition of the great arteries with VSD and pulmonary stenosis, seven double outlet right ventricle, three truncus arteriosus, two tetralogy of Fallot, three Sinus Venosus ASD, one multiple VSD and one congenitally abnormal aortic valve. Time for completing fusion process and the quality of fusion between CT and 3D-US were noted. Educational value was evaluated by fellows. Fusion was successful in all patients with median fusion quality scored 4/5. The median time to complete the fusion process was 735 seconds [628–1163] regardless of the cardiopathy complexity. Landmarks were significantly modified in complex congenital heart disease. Educational value was scored by fellows (C: No-Little value; B: Intermediate value; A: Major value) ( Fig. 1 ). Using Fusion modatily is feasible for everyone with little knowledge. The simultaneous visualization of intracardiac structures with fusion helps better understand anatomical relations of atrioventricular valves with outlets and helps young fellows in pediatric cardiology better visualize intracardiac repair and familiarize with congenital heart disease. Fusion technique can be routinely applied to patients regardless of their age and weight.