Author + information
- Received June 9, 2015
- Revision received September 15, 2015
- Accepted September 23, 2015
- Published online September 1, 2016.
- Francesco F. Faletra, MD∗ (, )
- Giovanni Pedrazzini, MD,
- Elena Pasotti, MD,
- Romina Murzilli, MD,
- Laura A. Leo, MD and
- Tiziano Moccetti, Prof.
- ↵∗Reprint requests and correspondence:
Dr. Francesco F. Faletra, Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano T1 CH-6900, Switzerland.
An echocardiography X-ray fusion allows for superimposing of 2-dimensional (2D)/3-dimensional (3D) transesophageal echocardiography (TEE) images on a fluoroscopic screen. This approach aligns 2D/3D TEE images into an x-ray fluoroscopic coordinate system. Any time the C arm of fluoroscopy moves, the 3D TEE image is automatically relocated according to the new x-ray projections (image-based tracking). Moreover, by means of a table-sided mouse, the echocardiographer can crop, rotate, or make the 3D TEE images more transparent.
Echocardiography–x-ray images are presented for several percutaneous procedures for structural heart disease, including transseptal puncture (Figure 1, Online Video 1), left atrial appendage occlusion (Figure 2, Online Video 2), transcatheter aortic valve replacement (TAVR) (Figure 3, Online Videos 3 and 4), balloon valvuloplasty in mitral stenosis (Figure 4, Online Video 5), and mitral valve repair (Figure 5, Online Videos 6, 7, and 8). For each step of the above-mentioned procedures, we illustrate echocardiography–x-ray fusion images and describe the current limitations using the traditional x-ray projections.
Echocardiography–x-ray imaging can help guide percutaneous procedures. However, it is still unclear whether this technique should have a “niche” application in a few complex procedures or whether it might be useful in all procedures. The poor resolution of 3D TEE images and the inability to display en face perspectives remain the main limitations.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 9, 2015.
- Revision received September 15, 2015.
- Accepted September 23, 2015.
- 2016 American College of Cardiology Foundation