Abstract
Objective
An interventional system for minimally invasive cardiac surgery was developed for therapy delivery inside the beating heart, in absence of direct vision.
Method
A system was developed to provide a virtual reality (VR) environment that integrates pre-operative imaging, real-time intra-operative guidance using 2D trans-esophageal ultrasound, and models of the surgical tools tracked using a magnetic tracking system. Detailed 3D dynamic cardiac models were synthesized from high-resolution pre-operative MR data and registered within the intra-operative imaging environment. The feature-based registration technique was employed to fuse pre- and intra-operative data during in vivo intracardiac procedures on porcine subjects.
Results
This method was found to be suitable for in vivo applications as it relies on easily identifiable landmarks, and hence, it ensures satisfactory alignment of pre- and intra-operative anatomy in the region of interest (4.8 mm RMS alignment accuracy) within the VR environment. Our initial experience in translating this work to guide intracardiac interventions, such as mitral valve implantation and atrial septal defect repair demonstrated feasibility of the methods.
Conclusion
Surgical guidance in the absence of direct vision and with no exposure to ionizing radiation was achieved, so our virtual environment constitutes a feasible candidate for performing various off-pump intracardiac interventions.
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References
Guiraudon G, Jones D, Bainbridge D, Peters T (2007) Mitral valve implantation using off-pump closed beating intracardiac surgery: a feasability study. Interact Cardiovasc Thorac Surg 6: 603–607
von Segesser L, Tozzi P, Augstburger M, Corno A (2003) Working heart off-pump cardiac repair (OPCARE)—the next step in robotic surgery?. Interact Cardiovasc Thorac Surg 2: 120–124
Suematsu Y, Marx GR, Stoll JA, Dupont PE, Cleveland RO, Howe RD, Triedman JK, Mihaljevic T, Mora BN, Savord BJ, Salgo IS, del Nido PJ (2004) Three-dimensional echo-guided beating-heart surgery without cardiopulmonary bypass: a feasibility study. J Thorac Cardiovasc Surg 128: 579–587
McVeigh ER, Guttman MA, Lederman RJ, Li M, Kocatruk O, Hunt T, Kozlov S, Horvath KA (2006) Real-time interactive MRI-guided cardiac surgery: aortic valve replacement using a direct apical approach. Magn Reson Med 56: 958–964
Hastenteufel M, Yang S, Christoph C, Vetter M, Meinzer H, Wolf I (2006) Image-based guidance for minimally invasive surgical atrial fibrillation ablation. Int J Med Robotics Comput Assist Surg 2: 60–69
DeBuck S, Maes A, Ecto J, Bogaert J, Dymarkowski S, Heidbnchel H, Suetens P (2005) An augmented reality system for patient-specific guidance of cardiac catheter ablation procedures. IEEE Trans Med Imaging 24: 1512–1524
Dong J, Dickfeld T, Dalal D, Cheema A, Vasamreddy C, Henrikson C, Marine J, Halperin H, Berger R, Lima J, Bluemke D, Calkins H (2006) Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17: 459–466
Vahanian A, Acar C (2005) Percutaneaous valve procedures: what is the future?. Curr Opin Cardiol 20: 100–106
Naqvi TZ, Zarbatany D (2006) Intracardiac echocardiography for percutaneous mitral valve repair in a swine model. J Am Soc Echocardiogr 19: 147–153
McVeigh ER, Guttman MA, Kellman P, Raval AA, Lederman RJ (2005) Real-time, interactive MRI for cardiovascular interventions. Acad Radiol 12: 1221–1227
Lauritsch G, Boese J, Wigström L, Kemeth H, Fahrig R (2006) Towards cardiac C-arm computed tomography. IEEE Trans Med Imaging 25: 922–934
Suematsu Y, Martinez JF, Wolf BK, Marx GR, Stoll JA, Dupont PE, Howe RD, Triedman JK, del Nido PJ (2005) Three-dimensional echo-guided beating-heart surgery without cardiopulmonary bypass: atrial septal defect closure in a swine model. J Cardiovasc Thorac Surg 130: 1348–1357
Linte CA, Moore J, Wiles AD, Wedlake C, Peters TM (2008) Virtual reality-enhanced ultrasound guidance: a novel technique for intracardiac interventions. Comput Aided Surg 13: 82–94
Linte CA, Wiles AD, Hill N, Moore J, Wedlake C, Guiraudon GM, Jones DL, Bainbridge D, Peters TM (2007) An augmented reality environment for image-guidance of off-pump mitral valve implantation. In: Medical imaging 2007: visualization and image-guided procedures. Proc of SPIE, vol 6509, 65090N-12
Wiles AD, Guiraudon GM, Moore J, Wedlake C, Linte CA, Jones DL, Bainbridge D, Peters TM (2007) Navigation accuracy for an intracardiac procedure using virtual reality-enhanced ultrasound. In: Medical imaging 2007: visualization and image-guided procedures. Proc of SPIE, vol 6509, 61410W-10
Smolíková-Wqchowiak R, Wachowiak MP, Fenster A, Drangova M (2003) Registration of tow-dimensional cardiac images to preprocedural three-dimensional images for interventional applications. J Magn Reson Imaging 22: 219–228
Wierzbicki M, Drangova M, Guiraudon GM, Peters TM (2004) Validation of dynamic heart models obtained using non-linear registration for virtual reality training, planning, and guidance of minimally invasive cardiac surgeries. Med Image Anal 8: 387–401
Schroeder WJ, Zarge JA, Lorensen WE (1992) Decimation of triangle meshes. In: Computer graphics—SIGGRAPH 92, pp 65–70
Wierzbicki M, Peters TM (2003) Determining epicardial surface motion using elastic registration: towards virtual reality guidance of minimally-invasive cardiac interventions. In: Proc of med image comput comput assist interv. Lect notes comput sci, vol 2878, pp 722–729
Gobbi DG, Comeau RM, Peters TM (1999) Ultrasound probe tracking for real-time ultrasound/MRI overlay and visualization of brain shift. In: Lecture notes in computer science. Proc of med image comput comput assist interv, vol 1679, pp 920–927
Linte CA, Wierzbicki M, Moore J, Guiraudon GM, Jones DL, Peters TM (2007) On enhancing planning and navigation of beating-heart mitral valve surgery using pre-operative cardiac models. Proc IEEE Eng Med Biol Soc 1: 475–478
Guiraudon GM (2005) Universal cardiac introducer. Patent Application US 2005/0137609 A1, Appl. No. 10/736,786
Wierzbicki M (2006) Subject-specific models of the heart from 4D images. PhD dissertation, University of Western Ontario, Canada
Linte CA, Wierzbicki M, Moore J, Guiraudon GM, Little SH, Peters TM (2007) Towards subject-specific models of the dynamic heart for mitral valve surgery. In: Proc of med image comput comput assist interv. Lect notes comput sci, vol 4792, pp 94–101
Bebek O, Cavusoglu MC (2007) Intelligent control algorithms for robotic-assisted beating heart surgery. IEEE Trans Rob Autom 23: 468–480
Bebek O, Cavusoglu MC (2006) Model based control algorithms for robotic assisted beating heart surgery. Proc IEEE Eng Med Biol Soc 1: 823–828
Cuvillon L, Gangloff J, De Mathelin M, Forgione A (2006) Towards robotized beating heart tecabg: assessment of the heart dynamics using high-speed vision. Comput Aided Surg 11: 267–277
Kettler DT, Plowes RD, Novotny PM, Vasilyev NV, del Nido PJ, Howe RD (2007) An active motion compensation instrument for beating heart mitral valve surgery. In: Proc of IEEE/RSJ international conference on intelligent robots and systems, vol 1, pp 1290–1295
Vogt S, Khamene A, Niemann H, Sauer F (2004) An AR system with intuitive user interface for manipulation and visualization of 3D medical data. In: Proceedings of medicine meets virtual reality. Stud health technol inform, vol 98, pp 397–403
Birkfellner W, Figl M, Matula C, Hummel J, Hanel R, Imhof H, Wanschitz F, Wagner A, Watzinger F, Bergmann H (2003) Computer-enhanced stereoscopic vision in a head-mounted operating binocular. Phys Med Biol 48: 49–57
Linte CA, Wiles A, Moore J et al (2008) Virtual reality-enhanced ultrasound guidance for atrial ablation: in vitro epicardial study. In: Lect notes comput sci, vol 5242, pp 644–651
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Linte, C.A., Moore, J., Wedlake, C. et al. Inside the beating heart: an in vivo feasibility study on fusing pre- and intra-operative imaging for minimally invasive therapy. Int J CARS 4, 113–123 (2009). https://doi.org/10.1007/s11548-008-0278-6
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DOI: https://doi.org/10.1007/s11548-008-0278-6