Integration of MDCT and fluoroscopy using C‐arm computed tomography to guide structural cardiac interventions in the cardiac catheterization laboratory

Abstract

Objectives Our study was aimed at evaluation of three‐dimensional (3D)‐CT overlay onto the catheterization laboratory fluoroscopy to guide structural cardiac interventions. Background: Current imaging for structural cardiac interventions (fluoroscopy, echocardiography) may not provide adequate guidance. The ability to integrate intracardiac 3D‐CT imaging data in the cardiac catheterization laboratory may be beneficial, but has not yet been systematically studied. Methods Thirty‐two patients undergoing various catheterization laboratory procedures (transcatheter aortic valve replacement, paravalvular leak (PVL) closure, pulmonary vein (PV) stenting, etc.) were prospectively enrolled. The goal was to evaluate the feasibility and benefit of overlaying pre‐procedural CT data onto the real‐time procedural fluoroscopic image using the Syngo DynaCT Cardiac C‐arm CT system (Siemens Healthcare, Forcheim, Germany). Results The overlay was considered most helpful for patients undergoing PVL closure and PV stenting. The additional radiation exposure of the C‐arm CT was a fraction of the total procedural dose (3.5% of total skin dose and 9.1% of total DAP). Conclusions Overlay of 3D‐CT data onto the real‐time procedural fluoroscopy in the cardiac catheterization laboratory is feasible to aide procedural guidance. The overlay was considered most helpful for patients undergoing PVL closure and PV stenting. The additional radiation dose is a small fraction of the total dose.