3D-Guided Percutaneous Pulmonary Valve Implantation: A Proposal of Multimodality Imaging and Guidance

Objectives: To optimize pre- and intraprocedural imaging for PPVI.

Methods: Planning percutaneous pulmonary valve implantation (PPVI), physiological and anatomical conditions have to be verified. Therefore, preinterventional MRI is usually performed. To check potential coronary compression from the stented valve, ballooning of the pulmonary artery (PA) with coronary contrast admission before implantation should be performed. Rotational angiography (3DRA) while ballooning and simultaneous contrast admission in the aortic root, the coronary compression can be visualized entirely. This 3DRA dataset can be used to registrate the MRI and to overlay it on live fluoroscopy for 3D-roadmapping without additional radiation or contrast dye consumption.

Results: Attempt for PPVI in 16 cases, successful implantation in 13 cases. Three cases with contraindications visualized by 3DRA; one of them with coronary compression by balloon test. Successful MRI-overlay and guidance in the last seven cases.

Conclusion: 3DRA during ballooning, the PA displays coronary compression. MRI-overlay with 3D guidance facilitates the implant procedure and has the potential to reduce fluoroscopic time. In addition, it is an advanced method to achieve more patient safety and may reduce radiation and contrast dye.

V42, Fig. 1: (A and B) VRT image from 3DRA: Arrow: coronary compression; (C) MRI overlay for intervention.