P2467Fusion imaging (Anatomical Intelligence) enables automated left atrial appendage sizing in real-time a single center pilot study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Afzal ◽  
V Veulemans ◽  
K Hellhammer ◽  
K Piayda ◽  
N Nijhof ◽  
...  
Keyword(s):  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Fusion Imaging ◽  
Atrial Appendage ◽  
Patient Specific ◽  
Heart Model ◽  
Landing Zone ◽  
Device Selection ◽  
The Mean

Abstract Background and purpose Percutaneous left atrial appendage occlusion (LAAO) depicts an alternative treatment for patients with atrial fibrillation who are deemed for long-term oral anticoagulation therapy. In order to perform a successful LAAO accurate sizing of left atrial appendage (ostium, landing zone and depth) for device selection is essential. Echo-Fluoro fusion imaging in real-time offers with its latest prototype a patient-specific segmented automated 3D heart model and sizing of left atrial appendage (LAA). We therefore aimed to evaluate the automated segmented LAA sizing by comparing to 2D transesophageal (TOE) and MSCT measurements as gold standard. Methods We studied prospectively data of 8 consecutive patients who were admitted to our clinic for left atrial appendage closure. MSCT was performed preprocedural and analyzed with commercially available 3mensio software (Pie medical imaging). 2D TOE measurements and automated segmentation of the LAA and sizing were performed during the procedure by a highly experienced team of periinterventional cardiac imaging specialist and structural heart disease interventionalist who were blinded to the prior MSCT analysis. Dimension of ostium, landing zone (10 mm into the LAA parallel to the ostial plane at the level of the left circumflex for Amplatzer device) and depth (perpendicular to the ostial plane) were obtained in different TOE views according to instructions for use of Amulet Occluder. In order to generate an automated 3 D heart model, a high-quality 3D TOE image of the LAA volume and surrounding structures was acquired. After successful ECG-gated segmentation a 3 D heart model was generated. Automated LAA sizing followed in real-time. All measurements were taken into consideration before device selection. A Kruskal Wallis test was used to compare mean ranks of independent samples. A concordance analysis according to Kendall W was carried out to investigate reliability. Results The mean age of the patients was 82,6±4.15 years and half of the patients were female. All procedures were conducted successfully. The mean values of ostium and landing zone were comparable in TOE, automated sizing and MSCT sizing (ostium: 23,78±2,15 mm vs 25,71±5,25 mm vs 27,35±3,3 mm; (p=0,175); landing zone 22,13±3,18 mm vs 23,57±3,31 mm vs 24,00±3,51 mm; (p=0,377)). Furthermore, a significant concordance between the measurements was shown (ostium W= 0,991; p=0.045, landing zone W=0,835, p=0.014). Conclusion Automated LAA sizing acquired by fusion imaging may be an elegant real-time alternative for precise LAA Occluder device selection and needs to be investigated further.

scholarly journals First experience with real-time 3D anatomical fusion imaging during left atrial appendage occluder implantation

2017 ◽  
Vol 18 (6) ◽  
pp. 719-720 ◽  
Author(s):  
Shazia Afzal ◽  
Dagmar Soetemann ◽  
Niels Nijhof ◽  
Malte Kelm ◽  
Tobias Zeus
Keyword(s):  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Fusion Imaging ◽  
Atrial Appendage

scholarly journals The Value of 3D Printing Models of Left Atrial Appendage Using Real-Time 3D Transesophageal Echocardiographic Data in Left Atrial Appendage Occlusion: Applications toward an Era of Truly Personalized Medicine

Cardiology ◽  
2016 ◽  
Vol 135 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Peng Liu ◽  
Rijing Liu ◽  
Yan Zhang ◽  
Yingfeng Liu ◽  
Xiaoming Tang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
3D Printing ◽  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
3D Models ◽  
Atrial Appendage ◽  
Patient Specific ◽  
The Real ◽  
Echocardiographic Image

Aims and Objectives: The objective of this study was to assess the clinical feasibility of generating 3D printing models of left atrial appendage (LAA) using real-time 3D transesophageal echocardiogram (TEE) data for preoperative reference of LAA occlusion. Background: Percutaneous LAA occlusion can effectively prevent patients with atrial fibrillation from stroke. However, the anatomical structure of LAA is so complicated that adequate information of its structure is essential for successful LAA occlusion. Emerging 3D printing technology has the demonstrated potential to structure more accurately than conventional imaging modalities by creating tangible patient-specific models. Typically, 3D printing data sets are acquired from CT and MRI, which may involve intravenous contrast, sedation, and ionizing radiation. It has been reported that 3D models of LAA were successfully created by the data acquired from CT. However, 3D printing of the LAA using real-time 3D TEE data has not yet been explored. Methods: Acquisition of 3D transesophageal echocardiographic data from 8 patients with atrial fibrillation was performed using the Philips EPIQ7 ultrasound system. Raw echocardiographic image data were opened in Philips QLAB and converted to ‘Cartesian DICOM' format and imported into Mimics® software to create 3D models of LAA, which were printed using a rubber-like material. The printed 3D models were then used for preoperative reference and procedural simulation in LAA occlusion. Results: We successfully printed LAAs of 8 patients. Each LAA costs approximately CNY 800-1,000 and the total process takes 16-17 h. Seven of the 8 Watchman devices predicted by preprocedural 2D TEE images were of the same sizes as those placed in the real operation. Interestingly, 3D printing models were highly reflective of the shape and size of LAAs, and all device sizes predicted by the 3D printing model were fully consistent with those placed in the real operation. Also, the 3D printed model could predict operating difficulty and the presence of a peridevice leak. Conclusions: 3D printing of the LAA using real-time 3D transesophageal echocardiographic data has a perfect and rapid application in LAA occlusion to assist with physician planning and decision making.

Real-time echocardiography-fluoroscopy fusion imaging for left atrial appendage closure: prime time for fusion imaging?

2021 ◽  
pp. 1-9
Author(s):  
Shazia Afzal ◽  
Kerstin Piayda ◽  
Katharina Hellhammer ◽  
Verena Veulemans ◽  
Georg Wolff ◽  
...  
Keyword(s):  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Fusion Imaging ◽  
Atrial Appendage ◽  
Prime Time ◽  
Left Atrial Appendage Closure

Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.F Du ◽  
H.M Chu ◽  
C.J Shen ◽  
B He
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Pulmonary Veins ◽  
Intracardiac Echocardiography ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Landing Zone ◽  
Electroanatomic Mapping System ◽  
The Mean ◽  
Fluoroscopy Exposure

Abstract Background Percutaneous left atrial appendage closure (LAAC) is currently guided by fluoroscopy and transesophageal echocardiography (TEE). Objective We report an LAAC technique using intracardiac echocardiography (ICE) and electroanatomic mapping system (EAMS) under local anesthesia without fluoroscopy exposure. Methods Seven non-valvular atrial fibrillation (NVAF) patients with high risk of stroke and bleeding (male 5/7, aged 71.7±8.8 years, mean CHA2DS2-VASc score 5.1±2.1; mean HAS-BLED score 3.0±1.2) were enrolled. ICE probe was advanced into left atrium (LA) navigated by the EAMS. LAA sizing and LAmbreTM device implantation were guided by ICE following the orthogonal tri-axial algorithm (Axis-X: from left pulmonary veins [LPVs] to LAA; Axis-Y: from right PV ostium to LAA; Axis-Z: from lower LA to LAA). Results There were two cauliflower-like, two chicken-wing-like and three cactus-like LAAs. The mean diameters of ostia and landing zone were 21.4±3.9mm and 20.4±4.2mm, respectively. LAmbre devices with a mean umbrella diameter of 23.7±4.2mm and cover disc diameter of 29.4±3.6mm were successfully implanted and acute complete LAA sealing without peri-device leak (PDL) were achieved in all cases. The mean procedural duration was 73.0±21.4min. No fluoroscopy exposure nor contrast consumption were recorded. No procedure-related complications were documented. The PDL at 45-day follow-up was 1.7±0.8mm. No stroke or thromboembolic events were documented. Conclusions The fluoroscopic exposure could be minimized, even to zero, in the ICE-guided LAAC procedures feasibly and safely using LAmbre devices. The orthogonal tri-axial assessment is considered efficacious and safe for the procedures. Orthogonal tri-axial algorithm Funding Acknowledgement Type of funding source: None

scholarly journals Multimodality Imaging for Optimal Device-size Selection During Percutaneous Left Atrial Appendage Closure in Thai Population

2021 ◽  
Author(s):  
Sakolwat Montrivade ◽  
Vorarit Lertsuwunseri ◽  
Monravee Tumkosit ◽  
Suphot Srimahach
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Landing Zone ◽  
Zone Diameter ◽  
Size Selection ◽  
The Mean ◽  
Implanted Device ◽  
Device Size ◽  
Laa Closure

Abstract Background: Optimal device size selection is crucial for percutaneous left atrial appendage (LAA) closure. Transesophageal echocardiography (TEE) is the standard imaging technique for LAA assessment, however there are discrepancies among different imaging modalities. We aimed to evaluate the agreement between device size and LAA size measured by three methods: multi-detector cardiac computed tomography (MDCT), TEE, and angiography. Methods: Patients who underwent percutaneous LAA closure at King Chulalongkorn Memorial Hospital from 2012 to 2020 were included in this study. MDCT, TEE and angiography were reviewed. LAA ostial diameter, landing zone diameter and maximal depth from each imaging modality was measured and analyzed. Agreement between landing zone diameter and implanted device size was assessed.Results: We reported on 61 consecutive patients who underwent percutaneous LAA closure. The mean age of patients was 74.0 ± 8.4 years. The mean CHA2DS2 score, CHA2DS2-VASc score and HAS-BLED score were 2.8 ± 1.4, 4.6 ± 1.8 and 2.6 ± 1.0, respectively. Device implantation was successful in all patients (100%). Two different LAA closure devices were used: Watchman (n = 43, 70.5%) and Omega (n = 18, 29.5%). Maximum landing zone diameter measured by MDCT scan, TEE and angiography were 23.4 ± 3.9 mm, 22.2 ± 4.8 mm and 22.7 ± 3.5 mm, respectively. MDCT measurement was significantly larger than TEE measurement (p = 0.015) and closer to implanted device size compared with TEE and angiography. The difference between landing zone diameter measured by CT scan and device size was -1.65 ± 2.0 mm compared with -4.8 ± 4.6 mm for TEE and -4.3 ± 3.3 mm for angiography.Conclusion: MDCT sizing of LAA results in larger measurement than TEE. Routine implementation of MDCT sizing may improve procedural success with more accurate device size selection.

Thrombus or Bilobar Left Atrial Appendage? Diagnosis by Real-Time Three-Dimensional Transesophageal Echocardiography

2009 ◽  
Vol 108 (1) ◽  
pp. 70-72 ◽  
Author(s):  
K Annette Mizuguchi ◽  
Thomas M. Burch ◽  
Bernard E. Bulwer ◽  
Amanda A. Fox ◽  
Robert J. Rizzo ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Three Dimensional ◽  
Atrial Appendage

Real-Time Three-Dimensional Echocardiography for Left Atrial Appendage Ligation

2009 ◽  
Vol 108 (5) ◽  
pp. 1467-1469 ◽  
Author(s):  
Robina Matyal ◽  
Swaminathan Karthik ◽  
Balachundhar Subramaniam ◽  
Peter Panzica ◽  
Sugantha Sundar ◽  
...  
Keyword(s):  
Real Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Three Dimensional ◽  
Atrial Appendage ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

scholarly journals Use of a Novel Septal Occluder Device for Left Atrial Appendage Closure in Patients With Postsurgical and Postlariat Leaks or Anatomies Unsuitable for Conventional Percutaneous Occlusion

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Domenico G. Della Rocca ◽  
Rodney P. Horton ◽  
Nicola Tarantino ◽  
Christoffel Johannes Van Niekerk ◽  
Chintan Trivedi ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Systemic Circulation ◽  
Atrial Appendage ◽  
Landing Zone ◽  
Septal Occluder Device ◽  
Occluder Device ◽  
Laa Closure

Background: Interventional therapies aiming at excluding the left atrial appendage (LAA) from systemic circulation have been established as a valid alternative to oral anticoagulation in patients at high thromboembolic risk. However, their efficacy on stroke prophylaxis may be compromised owing to incomplete LAA closure. Additionally, the need for an alternative thromboembolic prevention may remain unmet in patients with contraindications to oral anticoagulation whose appendage anatomy is unsuitable for some conventional devices commercially available. We aimed at evaluating the feasibility of LAA closure with the novel Gore Cardioform Septal Occluder in patients with incomplete appendage ligation or anatomic features which do not meet the manufacturer’s requirements for Watchman deployment. Methods: Twenty-one consecutive patients (mean age: 72±6 years; 85.7% males; CHA 2 DS 2 -VASc: 4.5±1.4; HAS-BLED: 3.6±1.0) were included. Transesophageal echocardiography was performed within 2 months to assess for residual LAA patency. Results: Fourteen patients had incomplete LAA closure following surgical (n=6) or Lariat ligation (n=8). In 7 patients with an appendage anatomy unsuitable for Watchman deployment, the mean maximal landing zone size and LAA depth were 14.4±1.3 and 18.6±2.8 mm. Successful Cardioform Septal Occluder deployment was achieved in all patients. No peri-procedural complications were documented. Procedure and fluoroscopy times were 46±13 and 14±5 minutes. Follow-up transesophageal echocardiography after 58±9 days revealed complete LAA closure in all patients. Conclusions: Transcatheter LAA closure via a Cardioform Septal Occluder device might be a valid alternative in patients with residual leaks following failed appendage ligation or whose LAA anatomy does not meet the minimal anatomic criteria to accommodate a Watchman device. Graphic Abstract: A graphic abstract is available for this article.

scholarly journals Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure

2020 ◽  
Vol 34 (6) ◽  
pp. 781-787
Author(s):  
Henning Ebelt ◽  
Thomas Domagala ◽  
Alexandra Offhaus ◽  
Matthias Wiora ◽  
Andreas Schwenzky ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Fusion Imaging ◽  
Atrial Appendage ◽  
Final Position ◽  
Procedure Time ◽  
Left Atrial Appendage Closure ◽  
X Ray

Abstract Background Left atrial appendage closure (LAAC) is an alternative treatment strategy for patients with atrial fibrillation who are at risk for thromboembolic events and considered not suitable for oral anticoagulation (OAC). LAAC is mainly performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. The study presented here should analyze whether fusion imaging (FI) of transesophageal echocardiography and X-ray performed during LAAC is feasible and can improve the results of the procedure. Methods The data presented here are from a retrospective single center study. Sample size was defined as 50 patients in which LAAC was performed without fusion imaging (control group) and 25 patients were the LAAC procedure was guided by fusion imaging (treatment group). Inclusion criteria were defined as age > 18 years and completion of an LAAC procedure defined as deployment of a WATCHMAN 2.5 LAA occluder. Study endpoints were procedure time, amount of used contrast medium, radiation dose, final position of the WATCHMAN in TEE (deviation from ideal positioning), and clinical endpoints, respectively. Results LAA closure was successfully performed in all patients. No case of device embolism was occurring, and none of the patients experienced a periprocedural stroke/TIA nor a systemic embolism, respectively. Mean procedure time was 15 min shorter in the group of patients where fusion imaging was applied (p < 0.001). Additionally, the use of fusion imaging was associated with a significant reduction of contrast medium (20.6 ml less than in control; p < 0.045). Regarding the final position of the WATCHMAN, no relevant differences were found between the groups. Summary The use of fusion imaging significantly reduced procedure time and the amount of contrast medium in patients undergoing LAAC.

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