Session PB7.1

Latest Technical Advances in the Cathlab through 3D Arteriography and 3D Coronary Angiography

T Hilbel*, D Lossnitzer, R Becker, W Rottbauer, HA Katus

University of Heidelberg
Heidelberg, Germany

For a long time the switch from analog to digital X-ray imaging seemed to be the only technical progress of X-ray fluoroscopy in the cardiac cathlab. But recently, two major 3D fluoroscopy imaging technologies for coronary angiography and electrophysiology were developed and brought into the clinical practice of the coronary angiography or electrophysiology laboratory. The 3D coronary angiography and the 3D arteriography methods take advantage of a new high speed C-arc X-ray gantry that acquires the image data while swinging over the patient's body. High speed personal computers with high performance graphic cards are then able to reconstruct 3D cardiac anatomy images from the rotational angiography acquisition almost in real time. In the Heidelberg University medical center one cathlab modality is equipped with the software and hardware to perform 3D coronary angiography, another cathlab modality is able to do 3D arteriography. 3D arteriography is useful for the electrophysiological ablation of atrial fibrillation. After a rotational angiography acquisition during contrast media injection the 3D anatomy of the left atrium and the pulmonary veins are obtained. The 3D anatomy of the atrium and the pulmonary veins can then be merged with the live fluoroscopy so that an optimized image guided electrical ablation within the atrium can be performed. 3D coronary angiography is also acquired through a high speed C-arc swing over the patient’s body while injecting contrast media into a coronary vessel. With the acquired data a 3D coronary angiography model of the coronary artery tree is calculated. The calculated 3D coronary angiography model is used to plan an optimal viewing angle for a interventional procedure with minimal foreshortening. The planning is done without the application of additional X-rays or contrast medium. Once the best viewing angle is found the computer moves the C-arc automatically to the position with the optimal viewing angle. Also the calculated 3D coronary angiography model is good to measure the right length for a stent before implantation. The new 3D cardiac image guided X-ray developments are intended to perform an optimal cardiac vessel intervention or an optimal electrophysiological ablation intervention with a reduced amount of X-ray exposure for both the patients and the clinical investigators.

(Abstract Control Number: 198)