Usefulness of echocardiographic-fluoroscopic fusion imaging in children with congenital heart disease

Summary Background Transoesophageal echocardiography (TOE) has become indispensable in the catheterization laboratory in the guidance of some percutaneous interventions, as a complementary imaging technique to fluoroscopy. However, the two imaging modalities are presented separately and differently, making interpretation of the anatomical spatial relationships complicated. EchoNavigator® (Philips Healthcare, Best, the Netherlands) is an innovative software package, enabling fusion of fluoroscopic and echocardiographic images on the same screen. Aims To assess the feasibility of EchoNavigator® in the guidance of interventional procedures, and to present our initial clinical experience with this software. Methods Children with congenital heart disease who underwent interventional catheterization needing guidance with TOE from December 2015 to December 2017 were included. TOE was realized using a X7-2t TOE probe (Philips Healthcare) connected to an echocardiographic system (EPIC™; Philips Healthcare, Andover, MA). Fluoroscopy was realized using the Allura Xper FD/10 system (Philips Healthcare). Image fusion was attempted in all patients using EchoNavigator®. Markers were positioned on the target zone on echocardiographic images, and projected onto the merged screen. Results Fifty-one children were included (mean age, 8 years; mean weight, 25 kg). Thirty-six patients underwent atrial septal defect closure, 10 ventricular septal defect closure, three aortic valve dilatation and two right ventricular outflow tract revalvulation. Image fusion was successfully obtained in all patients during all steps of the procedure. No complication related to the TOE probe was observed. Markers were successfully positioned in the all target zones, and were automatically projected onto the fusion screen. Conclusions The EchoNavigator® system is feasible and safe in the guidance of interventional catheterization in children with congenital heart disease; it enables better appreciation of anatomical relationships and improves the confidence of the interventionist.