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An Image Guided Hybrid Cardiac Interventions Lead to Successful Left Ventricular Pseud-Aneurysm Repair via minimal invasive approach
Odeaa Al jabbari, MD, Walid K. Abu Saleh, MD, Marie E Unruh, MD, ALAN LUMSDEN, MD, MAHESH RAMCHANDANI, MD.
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
OBJECTIVE: To report our institutional experience of using intra-operative C-arm Cone beam CT (CBCT) image fusion Guidance in a major cardiac surgery. We are presenting 83 year old gentleman with a left ventricular pseudoaneurysm status post myocardial rupture. The patient was approached via minimally invasive technique using CT Angiographic guided imaging with the dynaCT in the hybrid room
METHODS: The procedure was performed in the hybrid room, under general anesthesia in supine positing. DynaCT image fusion technique was included. A non-contrast rotational CT was performed prior to intervention and image fusion was utilized to fuse the previous obtained CT angiogram. Using the I-pilot software in the Syngo system the location of the LV pseudoaneurysm was electronically localized. The measurement was done vertically down from the last sternal wire and horizontally on the skin service. Skin marks were applied to location of the pseudoaneurysm and a 6 cm incision was made through the left intercostal space after the patient was placed on cardiopulmonary bypass (CBP) machine. The pseudoaneurysm cavity was entered and a primary closure was performed. The patient was weaned off the CBP machine and was transferred to the ICU in stable condition.
RESULTS: Appropriate CT angiography imaging were performed to assess the location of the aneurysm and cardiac function. We had a successful repair of a rare aneurysm of the left ventricle. Patient was discharge on post-operative day 9, the surgery was uneventful. Patient required only 2 units of blood. intensive care unite stay was 3 days.
CONCLUSIONS: C-arm Cone beam CT (DynaCT) image fusion affords the Cardiac surgeon a unique opportunity to use pre-operative images to advance intra-operative image guidance. Such image fusion strategies enhance routine 2D fluoroscopy by bringing 3D information of heart and the surrounding vasculature from pre-operative images and could play a potential role in minimizing the incisions required for approaching the targeted area in the heart.
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