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Computer-assisted navigation applied to fetal cardiac intervention
Abstract
BACKGROUND: Prenatal cardiac interventions (PCI) for human fetal aortic valve (AoV) stenosis can reduce left ventricular hypoplasia and restore ventricular growth and function. However, 'freehand' needle delivery from the maternal skin through the uterine wall, fetal chest and ventricular apex to cross the fetal AoV remains technically challenging and time intensive, and is the rate-limiting step in the procedure. METHODS: We developed a computer-assisted navigation (CANav) system that tracks the position and orientation of a two-dimensional (2D) ultrasound image relative to the trajectory of an electromagnetic (EM) embedded needle and stylet. We tested the CANav system in vitro using a water bath phantom, then in vivo using adult rats and pregnant (fetal) sheep. RESULTS: The CANav system accurately tracked the delivered needle position in both in vitro phantom and adult rat model experiments. We performed 22 PCI attempts with or without CANav in a fetal sheep model. Maternal laparotomy was required to adjust the fetal position in 50% of the procedures. The time required to deliver the needle from the skin into the left ventricle (LV) using CANav was 2.9 +/- 1.7 (range 2-7) min (n = 14) vs. 5.5 +/- 4.3 (range 1-12) min (n = 8) without CANav (p < 0.05). The time needed to cross the aortic valve once the needle was within the LV was similar with and without CANav (p = 0.19). CONCLUSIONS: CANav reduces the PCI time required to accurately deliver a needle to the fetal heart. Adaptations of this technical approach may be relevant to other congenital cardiac conditions and ultrasound-guided medical procedures.
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Advantages in pre-operative risk stratification or intraoperative assistance are described in both subspecialties of OB/GYN.
“the advantages in pre-operative risk stratification or intraoperative assistance are described in both subspecialties of OB/GYN, e.g., in pre-operative endometrial cancer staging [209] and for fetoscopic surgical interventions [69,127].”
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BIOGRAPHY and CONTACT INFORMATION
Keller, B. B., Blvd, E. M. A., & Logsdon, M. (2012)
Current awareness in prenatal diagnosis
(2008) · Prenatal Diagnosis · doi:10.1002/pd.1857
Metadata
- Authors
- Emery, S. P., Kreutzer, J., Sherman, F. R., Fujimoto, K. L., Jaramaz, B., Nikou, C., Tobita, K., & Keller, B. B.
- Affiliations
- University of Pittsburgh (US)
- Western Pennsylvania Hospital (US)
- Corresponding author
- Keller, Bradley B.
- ORCID
- Venue
- The International Journal of Medical Robotics and Computer Assisted Surgery
- Publisher
- Wiley
- Published
- 2007-08-30
- Volume
- 3
- Issue
- 3
- Pages
- 187-198
- ISSN
- 1478-5951 (ISSN-L)
- 1478-596X
- OpenAlex
- W2005138614
- Cited by
- 15
- References
- 41
- Citations by year
- 2023: 1 · 2019: 1 · 2018: 1 · 2016: 2 · 2015: 2 · 2014: 1 · 2012: 2
- FWCI
- 1.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Medical Robotics and Computer Assisted Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R44HL076961, R43HL076961)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- computer-assisted navigation, electromagnetic tracking, ultrasound-guided needle insertion, fetal sheep model, left ventricular hypoplasia, congenital heart disease
- MeSH terms
- Animals, Aortic Valve Stenosis, Equipment Design, Heart Defects, Congenital, Humans, Needles, Rats, Inbred Lew, Robotics, Cardiovascular Surgical Procedures, Ultrasonography, Prenatal, Ultrasonography, Interventional, Equipment Failure Analysis, Surgery, Computer-Assisted, Rats
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