Automated anatomical intelligence: next-generation fusion imaging for structural heart interventions

Cardiac teams performing structural heart interventions face unique imaging challenges, including separate image orientation and different imaging capabilities of the techniques involved.

Special software (EchoNavigator, Philips Health Care, Best, Netherlands) enables the fusion of three-dimensional trans-phageal echocardiography and fluoroscopy to correct such deficiencies. However, the visualization of complex anatomical structures and interventional precision in the beating heart remain a challenge.

Novel EchoNavigator software (examination device) with anatomical intelligence automatically generates a heart model with delineation of critical anatomical landmarks [PanelA1; model of the left ventricle and aortic root with needles of the aortic valve cusps (yellow triangles)]. Joint registration with the C-arm and the use of electrocardiogram gating allow live overlay of the model during fluoroscopy (PanelA2, supplementary online material, video S1).

TAVI

During transcatheter aortic valve implantation, model overlay can be used for optimal alignment of the annular plane prior to prosthesis implantation without the use of a contrast agent (dotted line on the needles in panelA3, supplemental online material, video S2) or for correct positioning of a temporary pacing lead ( arrowhead in panels B1 and B2 and supplemental online material (video S3 showing the heart at different angles).

MitraClip

During the MitraClip procedure (supplementary online material, video S4), the overlay of the heart model (PanelC1) and the automatically generated anatomical landmarks such as the opening of the left superior pulmonary vein (white triangle), the opening of the left atrial appendage (purple circle) and the mitral ring (arrow, PanelC2) ensure precise and safe catheter passage through the delicate left atrium. Advanced imaging technologies can therefore play an important role in increasing the efficacy and safety of structural heart interventions.