Automated segmentation of the atrial region and fossa ovalis towards computer-aided planning of inter-atrial wall interventions

Image-fusion strategies have been applied to improve inter-atrial septal (IAS) wall minimally-invasive interventions. Hereto, several landmarks are initially identified on richly-detailed datasets throughout the planning stage and then combined with intra-operative images, enhancing the relevant structures and easing the procedure. Nevertheless, such planning is still performed manually, which is time-consuming and not necessarily reproducible, hampering its regular application. In this article, we present a novel automatic strategy to segment the atrial region (left/right atrium and aortic tract) and the fossa ovalis (FO).Fundacão para a Ciência e a Tecnologia (FCT), in Portugal, and the European Social Found, European Union, for funding support through the “Programa Operacional Capital Humano” (POCH) in the scope of the PhD grants SFRH/BD/95438/2013 (P. Morais) and SFRH/BD/93443/2013 (S. Queirós). This work was funded by projects NORTE-01-0145-FEDER-000013, NORTE-01-0145-FEDER-000022 and NORTE-01-0145-FEDER-024300, supported by Northern Portugal Regional Operational Programme (Norte2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER), and also been funded by FEDER funds, through Competitiveness Factors Operational Programme (COMPETE), and by national funds, through the FCT, under the scope of the project POCI-01-0145-FEDER-007038info:eu-repo/semantics/publishedVersio

The role of imaging to support catheter ablation of atrial fibrillation

AbstractAtrial fibrillation (AF) ablation is a complex procedure that requires transseptal puncture and extensive manipulation with catheter(s) in the left atrium and pulmonary veins. Individual anatomy of these structures contributes to a challenge of AF ablation. The proximity of surrounding structures, such as esophagus, further increases risk of complications of this procedure. Increased risk of intracardiac thrombosis associated with AF is another factor that may complicate management of these patients. For all these reasons, imaging techniques play increasingly important role. Preprocedural imaging becomes important not only to rule out thrombus but also for assessment of anatomy of the PVs and left atrium, left atrial size and the extent of a substrate. Various forms of imaging help significantly during the procedure both with identification of anatomy and with catheter navigation. Many studies have shown increased efficacy, safety and decreased fluoroscopy times. After the procedure, imaging techniques such as echocardiography, CT or MR imaging are useful to diagnose potential complications. This paper briefly reviews clinical utility of different imaging tools for ablation of AF

The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging

Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of 'Interventional Imaging' for SHD interventions and a new dedicated professional figure, the 'Interventional Imager' with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.Cardiolog

Cardiac Catheterization in Congenital Heart Disease

Interventional pediatric cardiology is a specialty of pediatric cardiology that deals specifically with the catheter-based treatment of congenital heart diseases. Cardiac catheterization involves the evaluation and manipulation of the heart and surrounding vessels through catheters place in peripheral vessels. In this chapter we begin by discussing the significant difference between adult and pediatric interventional cardiology. We will discuss basic hemodynamic measurements performed in cardiac catheterization and its application to congenital heart disease. Stent and balloon catheters are briefly discussed. Finally, specific catheter based interventional techniques, indications, and complications for various pediatric congenital heart disease is described

Intracardiac Ultrasound Guided Systems for Transcatheter Cardiac Interventions

Transcatheter cardiac interventions are characterized by their percutaneous nature, increased patient safety, and low hospitalization times. Transcatheter procedures involve two major stages: navigation towards the target site and the positioning of tools to deliver the therapy, during which the interventionalists face the challenge of visualizing the anatomy and the relative position of the tools such as a guidewire. Fluoroscopic and transesophageal ultrasound (TEE) imaging are the most used techniques in cardiac procedures; however, they possess the disadvantage of radiation exposure and suboptimal imaging. This work explores the potential of intracardiac ultrasound (ICE) within an image guidance system (IGS) to facilitate the two stages of cardiac interventions. First, a novel 2.5D side-firing, conical Foresight ICE probe (Conavi Medical Inc., Toronto) is characterized, calibrated, and tracked using an electromagnetic sensor. The results indicate an acceptable tracking accuracy within some limitations. Next, an IGS is developed for navigating the vessels without fluoroscopy. A forward-looking, tracked ICE probe is used to reconstruct the vessel on a phantom which mimics the ultrasound imaging of an animal vena cava. Deep learning methods are employed to segment the complex vessel geometry from ICE imaging for the first time. The ICE-reconstructed vessel showed a clinically acceptable range of accuracy. Finally, a guidance system was developed to facilitate the positioning of tools during a tricuspid valve repair. The designed system potentially facilitates the positioning of the TriClip at the coaptation gap by pre-mapping the corresponding site of regurgitation in 3D tracking space

Transcatheter Mitral Valve Replacement: Current Evidence and Concepts

Over the past decade, several transcatheter devices have been developed to address the treatment of severe mitral regurgitation (MR) in patients at high surgical risk, mainly aimed at repairing the native mitral valve (MV). MV repair devices have recently been shown to have high efficacy and safety. However, to replicate promising trial results, specific anatomical and pathophysiological criteria have to be met and operators need a high level of experience. As yet, the longer-term durability of transcatheter MV repair remains unknown. Transcatheter MV replacement (TMVR) might be a treatment option able to target various anatomies, reliably abolish MR, and foster ease of use with a standardised implantation protocol. This review presents upcoming TMVR devices and available data and discusses how TMVR might further advance the field of transcatheter treatment of MR