Abstract
Purpose
Transesophageal echocardiography (TEE) is the preferred imaging modality in a hybrid procedure used to close ventricular septal defects (VSDs). However, the limited field of view of TEE hinders the maneuvering of surgical instruments inside the beating heart. This study evaluates the accuracy of a method that aims to support navigation guidance in the hybrid procedure.
Methods
A cardiologist maneuvered a needle to puncture the patient’s heart and to access a VSD, guided by information displayed in a virtual environment. The information displayed included a model of the patient’s heart and a virtual needle that reproduced the position and orientation of the real needle in real time. The physical and the virtual worlds were calibrated with a landmark registration and an iterative closest point algorithms, using an electromagnetic measurement system (EMS). For experiments, we developed a setup that included heart phantoms representing the patient’s heart.
Results
Experimental results from two pediatric cases studied suggested that the information provided for guidance was accurate enough when the landmark registration algorithm was fed with coordinates of seven points clearly identified on the surfaces of the physical and virtual hearts. Indeed, with a registration error of 2.28 mm RMS, it was possible to successfully access two VSDs (6.2 mm and 6.3 mm in diameter) in all the attempts with a needle (5 attempts) and a guidewire (7 attempts).
Conclusion
We found that information provided in a virtual environment facilitates guidance in the hybrid procedure for VSD closure. A clear identification of anatomical details in the heart surfaces is key to the accuracy of the procedure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Dakkak W, Oliver TI (2021) Ventricular septal defect. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK470330/. Accessed 10 January 2022
Amin Z, Danford DA, Lof J, Duncan KF, Froemming S (2004) Intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass: preliminary results with the perventricular technique. J Thoracic Cardiovasc Surg 127(1):234–241. https://doi.org/10.1016/j.jtcvs.2003.08.023
Zhang GC, Chen Q, Cao H, Chen LW, Yang LP, Chen DZ (2013) Minimally invasive perventricular device closure of ventricular septal defect in infants under transthoracic echocardiograhic guidance: feasibility and comparison with transesophageal echocardiography. Cardiovasc Ultrasound 11(1):1–6. https://doi.org/10.1186/1476-7120-11-8
Linte CA, Moore J, Wedlake C, Bainbridge D, Guiraudon GM, Jones DL, Peters TM (2009) Inside the beating heart: An in vivo feasibility study on fusing pre-and intra-operative imaging for minimally invasive therapy. Int J Comput Assist Radiol Surg 4(2):113–123. https://doi.org/10.1007/s11548-008-0278-6
Moore JT, Chu MW, Kiaii B, Bainbridge D, Guiraudon G, Wedlake C, Currie M, Rajchl M, Patel RV, Peters TM (2013) A navigation platform for guidance of beating heart transapical mitral valve repair. IEEE Trans Biomed Eng 60(4):1034–1040. https://doi.org/10.1109/TBME.2012.2222405
Li FP, Rajchl M, Moore J, Peters TM (2015) A mitral annulus tracking approach for navigation of off-pump beating heart mitral valve repair. Med Phys 42(1):456–468. https://doi.org/10.1118/1.4904022
Anwar S, Singh GK, Miller J, Sharma M, Manning P, Billadello JJ, Eghtesady P, Woodard PK (2018) 3d printing is a transformative technology in congenital heart disease. JACC: Basic Trans Sci 3(2):294–312. https://doi.org/10.1016/j.jacbts.2017.10.003
Yamada T, Osaka M, Uchimuro T, Yoon R, Morikawa T, Sugimoto M, Suda H, Shimizu H (2017) Three-dimensional printing of life-like models for simulation and training of minimally invasive cardiac surgery. Innovations 12(6):459–465. https://doi.org/10.1097/IMI.0000000000000423
Morais P, Tavares JMR, Queirós S, Veloso F, Dhooge J, Vilaça JL (2017) Development of a patient-specific atrial phantom model for planning and training of inter-atrial interventions. Med Phys 44(11):5638–5649. https://doi.org/10.1002/mp.12559
Tibamoso-Pedraza G, Navarro I, Dion P, Raboisson M-J, Lapierre C, Miró J, Ratté S, Duong L (2022) Design of heart phantoms for ultrasound imaging of ventricular septal defects. Int J Comput Assist Radiol Surg 17(1):177–184. https://doi.org/10.1007/s11548-021-02406-0
Ungi T, Lasso A, Fichtinger G (2016) Open-source platforms for navigated image-guided interventions. Med Image Anal 33:181–186. https://doi.org/10.1016/j.media.2016.06.011
Horn BK (1987) Closed-form solution of absolute orientation using unit quaternions. J Opt Soc Am A: Opt Image Sci Vis 4(4):629–642. https://doi.org/10.1364/JOSAA.4.000629
Acknowledgements
We thank Sarah Alohali for her contribution to this project.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This work was funded by Fonds de recherche du Québec - Nature et technologies (FRQNT), File: 276451.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval
Institutional review board approval was obtained for this retrospective study.
Availability of data and material
The clinical datasets cannot be publicly released. The material used in this study is commercially available.
Code availability
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tibamoso-Pedraza, G., Amouri, S., Molina, V. et al. Navigation guidance for ventricular septal defect closure in heart phantoms. Int J CARS 17, 1947–1956 (2022). https://doi.org/10.1007/s11548-022-02711-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11548-022-02711-2