Results from an International Multicenter Prospective Registry of Cardiac Catheterizations Guided with Fusion of Computed Tomography and Magnetic Resonance Imaging

Objectives: The aim of this study was to report the initial results from the first international prospective registry of cardiac catheterizations guided with fusion of computed tomography (CT) and magnetic resonance imaging (MRI) datasets. Developments in fusion imaging (FI) software have facilitated easy use of three-dimensional (3D) roadmaps based on preregistered CT or MRI datasets for guidance of cardiac catheterizations.

Methods: A multicenter prospective registry was set up to evaluate fusion of fluoroscopic two-dimensional (2D) images and the CT or MRI derived 3D roadmaps for guidance of cardiac catheterizations in congenital heart disease.

Result: From October 2016 until December 2018, FI was applied in 205 patients for guidance (n = 182) or planning (n = 23) of cardiac catheterization. Successful fusion of CT or MRI images was achieved in all cases. In 176 patients (96.7%) 2D to 3D registration was performed. In the remaining six patients 3D-3D registration was utilized. Accurate initial 3D roadmap alignment was achieved in 142 patients (78%). Seventeen patients (9.3%) required intraprocedural readjustment of the 3D roadmap due to distortion of the anatomy. Interventional procedures were performed in 137 patients (75.3%). In 37 patients (20.3%), catheterization was performed using only 3D guidance without additional angiography. Overall, 3D guidance with FI was deemed useful or essential in 98.3% of patients and not useful or misleading in three patients (1.7%).

Conclusion: Direct 2D to 3D registration of precatheterization CT or MRI is a safe and effective method of guidance of cardiac catheterization in congenital heart disease. In selected patients, FI facilitates percutaneous interventions without contrast angiography.