title: Integration of MDCT and fluoroscopy using C-arm computed tomography to guide structural cardiac interventions in the cardiac catheterization laboratory.
abstract: OBJECTIVE
  Our study was aimed at evaluation of three-dimensional (3D)-CT overlay onto the catheterization laboratory fluoroscopy to guide structural cardiac interventions.
  
  
  BACKGROUND
  Current imaging for structural cardiac interventions (fluoroscopy, echocardiography) may not provide adequate guidance. The ability to integrate intracardiac 3D-CT imaging data in the cardiac catheterization laboratory may be beneficial, but has not yet been systematically studied.
  
  
  METHODS
  Thirty-two patients undergoing various catheterization laboratory procedures (transcatheter aortic valve replacement, paravalvular leak (PVL) closure, pulmonary vein (PV) stenting, etc.) were prospectively enrolled. The goal was to evaluate the feasibility and benefit of overlaying pre-procedural CT data onto the real-time procedural fluoroscopic image using the Syngo DynaCT Cardiac C-arm CT system (Siemens Healthcare, Forcheim, Germany).
  
  
  RESULTS
  The overlay was considered most helpful for patients undergoing PVL closure and PV stenting. The additional radiation exposure of the C-arm CT was a fraction of the total procedural dose (3.5% of total skin dose and 9.1% of total DAP).
  
  
  CONCLUSIONS
  Overlay of 3D-CT data onto the real-time procedural fluoroscopy in the cardiac catheterization laboratory is feasible to aide procedural guidance. The overlay was considered most helpful for patients undergoing PVL closure and PV stenting. The additional radiation dose is a small fraction of the total dose. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Amar
authors.initials: A
authors.lastname: Krishnaswamy
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D061330:Multidetector Computed Tomography / Q000009:adverse effects / Q000379:methods*; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors
keywords: C-arm CT; DynaCT; catheterization laboratory imaging; paravalvular leak closure; pulmonary vein stenting; structural cardiac intervention