Echo-Navigation

In recent years there has been tremendous growth in the number and complexity of commonly performed transcatheter structural heart devices and procedures. Many of these procedures necessitate live transesophageal echocardiography (TEE) guidance, frequently employing 3-dimensional (3D) TEE to better visualize complex anatomy. TEE offers live, high-resolution images of cardiac soft tissues and Doppler non-invasive hemodynamics in a beating heart. However, a limitation of ultrasound-based imaging modalities is that they tend to have a relatively narrow field of view and they are somewhat limited in ability to image bony structures and catheters/devices. By contrast, fluoroscopy affords a wide field of view and offers excellent visualization of bony structures and catheters but very limited soft tissue visualization. Fusion imaging allows for the superimposition of 2D/3D TEE images on a fluoroscopic screen. Using live, automated TEE-fluoroscopic fusion we can gain a better understanding of device position relative to soft tissue anatomy to facilitate procedural guidance. In this chapter we will review the use of TEE-fluoroscopic fusion imaging for several commonly performed procedures.