Abstract
Minimally invasive beating heart intracardiac surgery is an area of research with many unique challenges. Surgical targets are in constant motion in a blood-filled environment that prevents direct line-of-sight guidance. The restrictive workspace requires compact, yet robust tools for proper therapy delivery. Our novel method for approaching multiple targets inside the beating heart allows their identification and access under augmented reality-assisted image guidance. The surgical platform integrates real-time ultrasound imaging with virtual models of the surgical instruments, along with virtual cardiac anatomy acquired from pre-operative images. Extensive in vitro studies were performed to assess the operator’s ability to “deliver therapy” to dynamic intracardiac targets via both transmural and transluminal access, and demonstrated significantly more accurate targeting under augmented reality guidance compared to ultrasound image guidance alone, accompanied by a reduction of procedure time by half. Moreover, preliminary in vivo acute studies on porcine models showed successful prosthesis positioning for beating-heart septal defect repair and mitral valve implantation via direct surgical access. While still in its infancy, this work emphasizes the promise of ultrasound-enhanced model-guided environments for minimally-invasive cardiac therapy, whether delivered via a catheter introduced into the vascular system or a cannula inserted through the heart wall.
This is a preview of subscription content, log in via an institution to check access.
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Harken, D.E., Ellis, L.B., Ware, P.F.: The surgical treatment of mitral stenosis: valvuloplasty. N. Engl. J. Med. 239, 801–809 (1948)
Gibbon, J.R.: Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 37, 171–185 (1954)
Lutter, G., Ardehali, R., Cremer, J., Bonhoeffer, P.: Percutaneous valve replacement: current state and future prospects. Ann. Thor. Surg. 78, 2199–2206 (2004)
Downing, S.W., Edmunds, L.H.: Release of vasoactive substances during cardiopulmonary bypass. Ann. Thorac. Surg. 54, 1236–1243 (1992)
Zeitlhofer, J., Asenbaum, S., Spiss, C., Wimmer, A., Mayr, N., Wolner, E., Deecke, L.: Central nervous system function after cardiopulmonary bypass. Eur. Heart J. 14, 885–890 (1993)
Linte, C.A., Moore, J., Wiles, A.D., Wedlake, C., Peters, T.M.: Virtual reality-enhanced ultrasound guidance: A novel technique for intracardiac interventions. Comput. Aided Surg. 13, 82–94 (2008)
Sauer, F.: Image registration: Enabling technology for image-guided surgery and therapy. In: Proc. of IEEE Eng. Med. Biol. Soc., pp. 7242–7245 (2005)
Wilson, K., Guiraudon, G.M., Jones, D.L., Peters, T.M.: 4D shape registration for dynamic electrophysiological cardiac mapping. In: Larsen, R., Nielsen, M., Sporring, J. (eds.) MICCAI 2006. LNCS, vol. 4191, pp. 520–526. Springer, Heidelberg (2006)
Wilson, K., Guiraudon, G.M., Jones, D.L., Linte, C.A., Wedlake, C., Moore, J., Peters, T.M.: Dynamic cardiac mapping on patient-specific models. In: Metaxas, D., Axel, L., Fichtinger, G., Székely, G. (eds.) MICCAI 2008, Part I. LNCS, vol. 5241, pp. 947–974. Springer, Heidelberg (2008)
Wierzbicki, M., Peters, T.M.: Determining epicardial surface motion using elastic registration: Towards virtual reality guidance of minimally-invasive cardiac interventions. In: Ellis, R.E., Peters, T.M. (eds.) MICCAI 2003. LNCS, vol. 2878, pp. 722–729. Springer, Heidelberg (2003)
Moore, J., Guiraudon, G.M., Jones, D.L., Hill, N., Wiles, A.D., Bainbridge, D., Wedlake, C., Peters, T.M.: 2D ultrasound augmented by virtual tools for guidance of interventional procedures. In: Proc. Medicine Meets Virtual Reality. Stud. Health Technol. Inform., vol. 125, pp. 322–327 (2007)
Linte, C.A., Wierzbicki, M., Moore, J., Guiraudon, G.M., Little, S.H., Peters, T.M.: Towards subject-specific models of the dynamic heart for mitral valve surgery. In: Ayache, N., Ourselin, S., Maeder, A. (eds.) MICCAI 2007, Part II. LNCS, vol. 4792, pp. 94–101. Springer, Heidelberg (2007)
Wiles, A.D., Linte, C.A., Moore, J., Wedlake, C., Peters, T.M.: Object identification accuracy under ultrasound enhanced virtual reality for minimally invasive cardiac surgery. In: Medical Imaging 2008: Visualization, Image-Guided Procedures and Modeling. Proc. of SPIE, vol. 6918 (2008) (in press)
Linte, C.A., Moore, J., Wedlake, C., Bainbridge, D., Guiraudon, G.M., Jones, D.L., Peters, T.M.: Inside the beating heart: An in vivo feasibility study on fusing pre- and intra-operative imaging for minimally invasive therapy. Int. J. CARS (2008), doi:10.1007/s11548-008-0278-6 (in press)
Linte, C.A., Wiles, A., Moore, J., Wedlake, C., Peters, T.M.: Virtual reality-enhanced ultrasound guidance for atrial ablation: In vitro epicardial study. In: Metaxas, D., Axel, L., Fichtinger, G., Székely, G. (eds.) MICCAI 2008, Part II. LNCS, vol. 5242, pp. 644–651. Springer, Heidelberg (2008)
Birkfellner, W., Figl, M., Matula, C., Hummel, J., Hanel, R., Imhof, H., Wanschitz, F., Wagner, A., Watzinger, F., Bergmann, H.: Computer-enhanced stereoscopic vision in a head-mounted operating binocular. Phys. Med. Biol. 48, 49–57 (2003)
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Peters, T.M. et al. (2009). Cardiac Imaging and Modeling for Guidance of Minimally Invasive Beating Heart Interventions. In: Ayache, N., Delingette, H., Sermesant, M. (eds) Functional Imaging and Modeling of the Heart. FIMH 2009. Lecture Notes in Computer Science, vol 5528. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-01932-6_50
Download citation
DOI: https://doi.org/10.1007/978-3-642-01932-6_50
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-01931-9
Online ISBN: 978-3-642-01932-6
eBook Packages: Computer ScienceComputer Science (R0)