Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-02T03:55:20.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Fusion imaging for guidance of pulmonary arteriovenous malformation embolisation with minimal radiation and contrast exposure

Published online by Cambridge University Press:  01 March 2024

Catalina Vargas-Acevedo Open the ORCID record for Catalina Vargas-Acevedo [Opens in a new window] ,
Ernesto Mejia ,
Jenny E. Zablah  and
Gareth J. Morgan Open the ORCID record for Gareth J. Morgan [Opens in a new window]
Catalina Vargas-Acevedo
Affiliation:
Department of Pediatric Cardiology, University of Colorado, The Heart Institute, Children’s Hospital Colorado, Aurora, CO, USA
Ernesto Mejia
Affiliation:
Department of Pediatric Cardiology, University of Colorado, The Heart Institute, Children’s Hospital Colorado, Aurora, CO, USA
Jenny E. Zablah
Affiliation:
Department of Pediatric Cardiology, University of Colorado, The Heart Institute, Children’s Hospital Colorado, Aurora, CO, USA
Gareth J. Morgan*
Affiliation:
Department of Pediatric Cardiology, University of Colorado, The Heart Institute, Children’s Hospital Colorado, Aurora, CO, USA
*
Corresponding author: G. J. Morgan; Email: drgarethjmorgan@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Hereditary haemorrhagic telangiectasia is an inherited disorder characterised by vascular dysplasia that leads to the development of arteriovenous malformations. Pulmonary arteriovenous malformations occur in approximately 30% of patients with haemorrhagic telangiectasia. Given the complex characteristics of haemorrhagic telangiectasia lesions, the application of three-dimensional fusion imaging holds significant promise for procedural guidance and decrease in contrast and radiation dosing. We reviewed all patients who underwent transcatheter approach for pulmonary arteriovenous malformation occlusion with fusion image guidance from June 2018 to September 2023 from a single centre. A total of nine cases with haemorrhagic telangiectasia and transcatheter occlusion of pulmonary arteriovenous malformations using fusion imaging were identified. Five (56%) were male, mean age at procedure was 15.7 years (10–28 years) and mean number of pulmonary arteriovenous malformations intervened was three per patient (1–7). Two of the cases were complex repeat embolisations. The mean fluoroscopy time was 40.6 min (10.7–68.8 min), with mean contrast dose of 28.8 mL (11–60 mL; mean of 0.51 mL/kg) and mean radiation dose of 66.3 mGy (25.6–140 mGy; mean of 40.5 mGy/m2). There were no complications reported during the procedures, with no additional interventions necessary. Fusion imaging in pulmonary arteriovenous malformations embolisation for patients with haemorrhagic telangiectasia is feasible and has the potential to reduce contrast and radiation doses. To our knowledge, we describe the lowest radiation and contrast doses per patient using fusion imaging technology reported in the literature to date.

Keywords

pulmonary artery embolisationfusion imaginghereditary haemorrhagic telangiectasia
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 5
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Garg, N, Khunger, M, Gupta, A, Kumar, N. Optimal management of hereditary hemorrhagic telangiectasia. J Blood Med 2014; 5: 191. DOI: 10.2147/JBM.S45295.Google Scholar
Azad, F, Miranda, CJ, Sparacino, GM. Pulmonary arteriovenous malformation in a rare case of hereditary hemorrhagic telangiectasia. Cureus 2022; 14(12): e32365. DOI: 10.7759/cureus.32365.Google Scholar
Rajesh, GN, Sajeer, K, Nair, A, Haridasan, V, Sajeev, CG, Krishnan, MN. Device closure of pulmonary arteriovenous malformation using Amplatzer vascular plug II in hereditary hemorrhagic telangiectasia. Indian Heart J 2015; 67: 455–458.Google Scholar
Tau, N, Atar, E, Mei-Zahav, M, et al. Amplatzer vascular plugs versus coils for embolization of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. Cardiovasc Intervent Radiol 2016; 39: 1110–1114.CrossRefGoogle ScholarPubMed
Muhammad, A, Rauf, Z, Shahid, J, Iqbal, J, Haq, TU, Zafar, U. Endovascular embolisation of pulmonary arteriovenous malformation using amplatzer vascular plugs. Cureus 2022; 14(4): e24214. DOI: 10.7759/cureus.24214.Google Scholar
Nobre, C, Oliveira-Santos, M, Paiva, L, Costa, M, Gonçalves, L. Fusion imaging in interventional cardiology PALAVRAS-CHAVE. Rev Port Cardiol 2020; 39: 463–473.Google Scholar
Goreczny, S, Morgan, GJ, McLennan, D, Rehman, R, Zablah, JE. Comparison of fusion imaging and two-dimensional angiography to guide percutaneous pulmonary vein interventions. Kardiol Pol 2022; 80: 476–478.Google Scholar
Markelj, P, Tomaževič, D, Likar, B, Pernuš, F. A review of 3D/2D registration methods for image-guided interventions. Med Image Anal 2012; 16: 642–661.CrossRefGoogle ScholarPubMed
Garnier, M, Curado, A, Grancher, A, et al. Fusion imaging for pulmonary artery embolization: impact on fluoroscopy duration and contrast agent exposure. Br J Radiol 2023; 96(1151): 20220815. DOI: 10.1259/bjr.20220815.CrossRefGoogle ScholarPubMed
Ehret, N, Alkassar, M, Dittrich, S, et al. A new approach of three-dimensional guidance in paediatric cath lab: segmented and tessellated heart models for cardiovascular interventions in CHD. Cardiol Young 2018; 28: 661–667.Google Scholar
Goreczny, S, Moszura, T, Dryzek, P, et al. Three-dimensional image fusion guidance of percutaneous pulmonary valve implantation to reduce radiation exposure and contrast dose: a comparison with traditional two-dimensional and three-dimensional rotational angiographic guidance. Neth Heart J 2017; 25: 91–99.Google Scholar
Zablah, JE, Morgan, GJ. Innovations in congenital interventional cardiology. Pediatr Clin North Am 2020; 67: 973–993.Google Scholar
Cevallos, PC, Armstrong, AK, Glatz, AC, et al. Radiation dose benchmarks in pediatric cardiac catheterization: a prospective multi-center C3PO-QI study. Catheter Cardio Interv 2017; 90: 269–280.CrossRefGoogle ScholarPubMed
Kleinerman, RA. Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 2006; 36: 121–125.Google Scholar
Miglioretti, DL, Johnson, E, Williams, A, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013; 167: 700–707.Google Scholar
Zablah, JE, Rodriguez, SA, Leahy, R, Morgan, GJ. Novel minimal radiation approach for percutaneous pulmonary valve implantation. Pediatr Cardiol 2021; 42: 926–933.Google Scholar