超声心动图-透视融合成像与迷你三维经食管探头在儿科患者中的应用

IF 2.2 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2025-09-01 DOI:10.1016/j.acvd.2025.06.060

Ramona Ghenghea , Hadeed Khaled , Paul Vignaud , Nicolas Combes , Aitor Guitarte , Yves Dulac , Miarisoa Ratsimandresy , Julie Gobin , Philippe Acar , Clement Karsenty

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引用次数: 0

摘要

超声-透视融合（EFF）成像将实时超声心动图与透视相结合，以改善成人心脏病学中已建立的介入过程中的指导。由于缺乏合适的探针，它的儿科应用受到限制，但由于儿科专用3D探针，现在在30公斤以下的患者中是可行的。本研究旨在评估EFF成像在先天性心脏病（CHD）儿科导管插入术中的可行性、安全性和临床应用。方法前瞻性研究于2024年9月至12月使用EchoNavigator （Philips Healthcare）将新型超声心动图探头（X11-4T）与x线检查（Allura Azurion 7）联合注册。2D/3D EFF成像的质量、准确性和实用性采用5分李克特量表进行评估。结果图卢兹儿童医院儿科心脏科共纳入22例儿童（中位年龄5.4岁[1.2 ~ 17.8岁]，体重18.5 [8 ~ 61]kg）。所有手术均成功实施了EFF成像，融合稳定性良好。2例患者行诊断性置管术，11例房间隔缺损（ASD）患者和9例室间隔缺损患者分别采用不同的装置进行封闭。二维EFF成像质量为5/5 (95% CI: 4-5)，三维EFF成像质量为4/5 （95% CI: 4-5）。EFF成像的准确度为5/5 (95% CI: 5-5)，其效用为3/5 （95% CI: 3-4）。未发生探针插入或图像融合相关并发症。EFF成像为准确放置设备提供了清晰的实时指导，特别是在双asd等复杂病例中，并增强了解剖可视化，为复杂冠心病（如cc-TGA伴右心）的手术导航提供了便利。结论eff显像是指导小儿冠心病介入治疗的一种可行、安全的技术。它显著改善了解剖可视化、设备放置以及介入医师和超声心动图医师之间的沟通，特别是在复杂的病例中。这项技术有望推进儿童心脏干预。

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Echocardiographic-Fluoroscopic fusion imaging with the mini 3D transesophageal probe in pediatric patients

Introduction

Echo-fluoroscopy fusion (EFF) imaging integrates real-time echocardiography with fluoroscopy to improve guidance during interventional procedures with established use in adult cardiology. Its pediatric application was limited by the absence of suitable probes but is now feasible in patients under 30 kg due to pediatric-specific 3D probes. This study aimed to evaluate the feasibility, safety, and clinical utility of EFF imaging in pediatric catheterization for congenital heart disease (CHD).

Method

A prospective study was conducted between September and December 2024 using EchoNavigator (Philips Healthcare) to co-register the new echocardiography probe (X11-4T) with fluoroscopy (Allura Azurion 7). The quality, accuracy, and utility of 2D/3D EFF imaging were assessed on a 5-point Likert scale.

Results

Twenty-two children (median [range] age 5.4 years [1.2–17.8 years]; weight 18.5 [8–61] kg) were enrolled from the pediatric cardiology unit at the Children's Hospital of Toulouse. EFF imaging was successfully implemented in all procedures with excellent fusion stability. Two patients underwent diagnostic catheterization, while atrial septal defect (ASD) and ventricular septal defect closures were performed in 11 and 9 patients, respectively, using various devices. The quality of 2D EFF imaging was rated 5/5 (95% CI: 4–5), while the quality of 3D EFF imaging was 4/5 (95% CI: 4–5). The accuracy of EFF imaging was rated 5/5 (95% CI: 5–5), and its utility was 3/5 (95% CI: 3–4). No complications related to probe insertion or image fusion occurred. EFF imaging provided clear real-time guidance for accurate device placement, particularly in complex cases like double ASDs and enhanced anatomical visualization, facilitating procedural navigation in complex CHD like cc-TGA with dextrocardia.

Conclusion

EFF imaging is a feasible and safe technique for guiding pediatric interventional procedures in CHD. It significantly improves anatomical visualization, device placement, and communication between the interventionalist and echocardiographer, especially in complex cases. This technology holds promise for advancing pediatric cardiac interventions.

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.