Enhanced Guidance for Aortic Valve Positioning

© Siemens AG 2013 All rights reserved. H IM AX 11/12-193 Answers for life.
syngo Aortic ValveGuide
Enhanced workflow and accuracy for valve
positioning
Clinical applications

Siemens Healthcare, Angiography & Interventional X-Ray Systems
© Siemens AG 2013 All rights reserved. H IM AX 11/12-193
Three essential benefits for valve implantations
Automated workflow
through fully automatic aortic root segmentation, indication of anatomical landmarks
and synchronization of C-arm angulation to perpendicular view – in seconds
Improved guidance
through landmarks and overlay of segmented 3D structures onto live 2D fluoroscopy
Dose and contrast medium savings
through 3D guidance based on syngo DynaCT Cardiac acquisition and ideal
automatic C-arm positioning without additional fluoroscopy

“We've been using syngo DynaCT for a long time now. It allows us
to evaluate the anatomy of the aortic root and the position of the
coronary ostia. The overlay of the intra-procedural 3D image over
live fluoroscopy gives us an additional level of confidence for the
valve implantation. Since October 2011 we've now been using
syngo Aortic ValveGuide. The automated workflow makes the
procedure easier and the indication of a perpendicular view plane
helps to make it even safer.”
The statements by Siemens’ customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no "typical"
hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same
results.
William W. O’Neill, University of Miami, USA
Customer testimonial I

“syngo Aortic ValveGuide makes it so quick and easy for us to find
the optimal perpendicular view on the annulus. The software does
everything automated. Based on the DynaCT Cardiac images it
derives the optimal plane for the valve implantation and then we
can synchronize the
C-arm projection with this view without giving additional root
shots.”
Dr. Jörg Kempfert, Heart Center Leipzig, Germany
Customer testimonial II
The statements by Siemens’ customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no "typical"
hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same
results.

Fluoroscopic guidance for valve deployment
The gold standard of the past
Images courtesy of Heart Center Leipzig
Valve deployment with 2D guidance
Transfemoral approach

A new level of valve positioning convenience

2D images cannot deliver sufficiently precise information for angulation and
placement
• Perpendicular projection required to ensure proper valve deployment while minimizing risk
of aortic regurgitation
• Correct placement crucial to avoid blockage of coronary arteries or valve dislocation
• Anatomical information in 3D needed for implantation of non-rotationally symmetric valves
Challenges when implanting transcatheter valves

A new level of valve positioning convenience
• Efficiency
A single syngo DynaCT Cardiac acquisition is sufficient for finding an perpendicular view
to implant the valve and to understand the anatomy of the coronary ostiae
• Confidence
Implantation height in relation to aortic root present during whole procedure ensuring correct
valve placement
• Ready for future valve generations
3D imaging provides anatomical information (e.g. valve cusps, commissure lines)
required for implantation of anatomical valves
That meansThat means

Efficient guidance for valve implantations
• No user interaction needed – no need to leave sterile area
• Reconstruction, segmentation and landmarks in less than 30 seconds
• Potential contrast media and dose savings when compared to conventional CT or 2D imaging
Automated workflow
Rotational angiography syngo DynaCT Cardiac
Reconstruction
Segmentation

Segmentation and landmark detection
• recognizes and represents the aortic root
• detects and indicates coronary ostiae and
lowest cusp points of aortic valve (nadir points)
• reconstructs commissure lines of aortic
valve (WIP)
• selects perpendicular view plane
The software automatically…
Image courtesy of Herz- und Kreislaufzentrum Rotenburg a.d. Fulda

Perpendicular new plane
Optimum angulation – perpendicular to annulus
A circle parallel to the plane spanned by
the three lowest points of the cusps
is derived
The circle is transformed into a straight line when
the three lowest cusp points are aligned, providing
optimal perpendicular angulation

Contour view – focus on the essentials
• show only the essential landmarks needed for
prosthesis positioning and deployment steps
• allow for display of additional fluoroscopic
information
Switch to contour mode during 2D/3D overlay to…
Image courtesy of Kerckhoff-Klinik, Bad Nauheim

Overlay of 3D and live fluoro
• facilitates orientation during valve positioning
• guides valve deployment
• overlay is dynamically adapted to C-arm rotations
and table movements
Dynamic overlay with syngo iPilot
Image courtesy of Kerckhoff-Klinik, Bad Nauheim

Key features
• Automatic intraprocedural segmentation and
display of aortic root anatomy in 3D based on
syngo DynaCT
• Anatomic landmarks to guide the valve
deployment, e.g. coronary ostia, nadir points
• Indication of perpendicular view to adjust the
C-arm projection for confidence in valve positioning
• Contour view for exact positioning by showing the
device in the aortic root and the landmarks in live
fluoro overlay
Better planning and orientation during valve deployment
Image courtesy of Herz- und Kreislaufzentrum Rotenburg a.d. Fulda and Kerckhoff-Klinik Bad Nauheim

Key take-aways
• Improved guidance and increased procedural safety through overlay of 3D information
and anatomical landmarks
• Speed and efficiency with automated workflow from rotational angiography to segmentation
and 3D overlay in less than 25 seconds
• Possible contrast savings thanks to 3D guidance and adjustment of C- arm to perpendicular view

Workflow during trans-apical implantation of Edwards Sapien valve

Implantation of Medtronic Corevalve
Image courtesy of Herz- und Kreislaufzentrum Rotenburg a.d. Fulda

Angiography & Interventional X-Ray Systems.
Answers for life.
On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this presentation are available through the Siemens sales
organization worldwide. Availability and packaging may vary by country and are subject to change without prior notice.

Enhanced Guidance for Aortic Valve Positioning

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