Results from an international multi-center prospective registry of cardiac catheterizations and percutaneous cardiac interventions guided with three-dimensional imaging

Introduction: Developments in fusion imaging (FI) software have facilitated easy use of three-dimensional (3D) roadmaps based on preregistered computed tomography (CT) or magnetic resonance imaging (MRI) datasets for guidance of cardiac catheterizations. Aim: The aim of this study was to report the initial results from the first international prospective registry of cardiac catheterizations guided with fusion of CT and MRI datasets. Material and methods: A multi-center prospective registry was set up to evaluate fusion of fluoroscopic two-dimensional (2D) images and the CT- or MRI-derived 3D roadmaps for guidance of cardiac catheterizations in congenital heart disease. Results: = 23) of cardiac catheterization. Successful fusion of CT or MRI images was achieved in all cases. In 176 (96.7%) patients, 2D-3D registration was performed. In the remaining 6 patients, 3D-3D registration was utilized. Accurate initial 3D roadmap alignment was achieved in 142 (78%) patients. Seventeen (9.3%) patients required intra-procedural readjustment of the 3D roadmap due to distortion of the anatomy. Interventional procedures were performed in 137 (75.3%) patients. In 37 (20.3%) patients, catheterization was performed using only 3D guidance without additional angiography. Overall, 3D guidance with FI was deemed at least useful in 98.3% of patients and not useful or misleading in 3 (1.7%) patients. Conclusions: Direct 2D-3D registration of pre-catheterization CT or MRI is a safe and effective method of guidance of cardiac catheterization in selected congenital heart disease cases. In selected patients, FI facilitates percutaneous interventions without contrast angiography.