Basic Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2015; 7(9): 562-570
Published online Sep 26, 2015. doi: 10.4330/wjc.v7.i9.562
Initial clinical experience using the EchoNavigator®-system during structural heart disease interventions
Jan Balzer, Tobias Zeus, Katharina Hellhammer, Verena Veulemans, Silke Eschenhagen, Eva Kehmeier, Christian Meyer, Tienush Rassaf, Malte Kelm
Jan Balzer, Tobias Zeus, Katharina Hellhammer, Verena Veulemans, Silke Eschenhagen, Eva Kehmeier, Christian Meyer, Tienush Rassaf, Malte Kelm, Division of Cardiology, Pneumology and Angiology, Department of Medicine, University Hospital Duesseldorf, 40225 Duesseldorf, Germany
Author contributions: Balzer J and Zeus T designed the concept of the study, prepared the manuscript and figures, performed the interventional procedures and drafted the manuscript; Hellhammer K and Veulemans V performed the clinical and echocardiographic data assessment before and during the intervention; Eschenhagen S and Kehmeier E made critical revisions related to the quality of the acquired data and participated in the creation of figures and images; Meyer C, Rassaf T and Kelm M participated in the performance of the interventional procedures, and in the design and review of the manuscript; all authors read and approved the final manuscript.
Supported by A Restricted Grant from the Federal State Government of North Rhine-Westphalia and the European Union (EFRE-Program “Med in.NRW”), No. 005-GW01-235A.
Institutional review board statement: No ethical approval by the local institutional review board was necessary for the additional application of this novel fusion imaging technology. The data analysis was conducted retrospectively without the necessity of providing an ethics committee approval.
Institutional animal care and use committee statement: Animal experiments were not performed for the conduction of this study.
Conflict-of-interest statement: Jan Balzer has received fees for serving as a speaker from Philips Healthcare. Other authors have none conflict of interest to declare.
Data sharing statement: Technical appendix, statistical code, and datasets are available from the corresponding author. Participants gave written informed consent for the performance of each interventional procedure. Written informed consent was not obtained for the additional application of the fusion imaging software. The presented data are anonymized and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. med. Jan Balzer, Division of Cardiology, Pneumology and Angiology, Department of Medicine, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany. jan.balzer@med.uni-duesseldorf.de
Telephone: +49-211-8118800 Fax: +49-211-8118812
Received: May 17, 2015
Peer-review started: May 21, 2015
First decision: June 3, 2015
Revised: July 7, 2015
Accepted: August 16, 2015
Article in press: August 17, 2015
Published online: September 26, 2015
Processing time: 125 Days and 22.5 Hours
Abstract

AIM: To present our initial clinical experience using this innovative software solution for guidance of percutaneous structural heart disease interventions.

METHODS: Left atrial appendage, atrial septal defect and paravalvular leak closure, transaortic valve repair and MitraClip® procedures were performed in the catheter laboratory under fluoroscopic and echocardiographic guidance. The two-dimensional and three-dimensional images generated by the transesophageal echocardiography probe were interfaced with the fluoroscopic images in real-time using the EchoNavigator®-system.

RESULTS: The application of the novel image fusion technology was safe and led to a better appreciation of multimodality imaging guidance due to improved visualization of the complex relationship between catheter devices and anatomical structures.

CONCLUSION: The EchoNavigator®-system is a feasible and safe tool for guidance of interventional procedures in structural heart disease. This innovative technology may improve confidence of interventional cardiologists in targeting and positioning interventional devices in order to increase safety, accuracy, and efficacy of percutaneous interventions in the catheter laboratory.

Keywords: Fusion imaging; Interventional guidance; Percutaneous interventions; Structural heart disease; Echocardiography

Core tip: Interventions in structural heart disease require adequate echocardiographic and fluoroscopic imaging for safe accomplishment of the procedure. Recently, a novel fusion imaging technology has been introduced, allowing for the first time to merge echocardiographic and fluoroscopic images in the catheter laboratory in real time. As one of the first centers worldwide, we used this innovative technology for guidance of interventions in structural heart disease, demonstrating its potential benefits for guiding complex interventions in structural heart disease.