In-vitro Validation of Image Guided Surgery System with 3D Pre-Operative Visualization for Atrial Transseptal Puncture

Abstract

The left atrium (LA) is the most difficult cardiac chamber to access percutaneously. The route through the systemic venous system across the interatrial septum is mostly preferred to the more retrograde arterial route as larger catheters and devices could be manipulated safely. The transseptal (TS) puncture permits this direct route to the LA through the interatrial septum which is necessary in patients with a trial fibrillation (cardiac ablation), patent fossa ovalis (PFO), a trial septal defect (ASD) repair, left atrium appendage closure, balloon mitral valvuoloplasty, pulmonary vein stenos is intervention, Ante grade ventricular septal defect closure, stent implantation in the right internal carotid artery. For a safe TS puncture, one requires a delivery system and medical imaging software. At present doctors use biplanar fluoroscopic images during navigation and TS puncture. The two-dimensional echocardiography aids the doctor during the TS puncture. A complete three-dimensional visualization is yet to be established. We propose an efficient method for target localization pre-operatively and three-dimensional visualization with respect to catheter tip of the scene during the procedure. This technique eliminates fluoroscopy. The technique proposed in this work has been validated in-vitro using an a trial phantom, used to train doctors in electrophysiology (EP) labs. The pre-operative image obtained using MRI is registered with the phantom and the catheter tip location inside the phantom and is visualized in three-dimensions.