Ultrasound based mitral valve annulus tracking for off-pump beating heart mitral valve repair

Mitral regurgitation (MR) occurs when the mitral valve cannot close properly during systole. The NeoChord© tool aims to repair MR by implanting artificial chordae tendineae on flail leaflets inside the beating heart, without a cardiopulmonary bypass. Image guidance is crucial for such a procedure due to the lack of direct vision of the targets or instruments. While this procedure is currently guided solely by transesophageal echocardiography (TEE), our previous work has demonstrated that guidance safety and efficiency can be significantly improved by employing augmented virtuality to provide virtual presentation of mitral valve annulus (MVA) and tools integrated with real time ultrasound image data. However, real-time mitral annulus tracking remains a challenge. In this paper, we describe an image-based approach to rapidly track MVA points on 2D/biplane TEE images. This approach is composed of two components: an image-based phasing component identifying images at optimal cardiac phases for tracking, and a registration component updating the coordinates of MVA points. Preliminary validation has been performed on porcine data with an average difference between manually and automatically identified MVA points of 2.5mm. Using a parallelized implementation, this approach is able to track the mitral valve at up to 10 images per second.

[1]  Feng Li,et al.  Towards real-time 3D US-CT registration on the beating heart for guidance of minimally invasive cardiac interventions , 2012, Medical Imaging.

[2]  Terry M. Peters,et al.  Real-time segmentation in 4D ultrasound with continuous max-flow , 2012, Medical Imaging.

[3]  Terry M. Peters,et al.  Towards Model-Enhanced Real-Time Ultrasound Guided Cardiac Interventions , 2011, 2011 International Conference on Intelligent Computation and Bio-Medical Instrumentation.

[4]  John Moore,et al.  Augmented Reality Image Guidance Improves Navigation for Beating Heart Mitral Valve Repair , 2012, Innovations.

[5]  R. Daly,et al.  Beating-heart, off-pump mitral valve repair by implantation of artificial chordae tendineae: an acute in vivo animal study. , 2009, The Journal of thoracic and cardiovascular surgery.

[6]  Jocelyne Troccaz,et al.  Author manuscript, published in "IEEE International Symposium on Biomedical Imaging, ISBI’06, Arlington: United States (2006)" TRACKING OF THE MITRAL VALVE LEAFLET IN ECHOCARDIOGRAPHY IMAGES , 2008 .

[7]  Terry M. Peters,et al.  Feature identification for image-guided transcatheter aortic valve implantation , 2012, Medical Imaging.

[8]  R A Levine,et al.  Prevalence and clinical outcome of mitral-valve prolapse. , 1999, The New England journal of medicine.

[9]  R A Levine,et al.  The relationship of mitral annular shape to the diagnosis of mitral valve prolapse. , 1987, Circulation.

[10]  James D. Thomas,et al.  Segmentation and tracking of mitral valve leaflets in echocardiographic sequences: active contours guided by optical flow estimates , 1996, Medical Imaging.

[11]  Terry M. Peters,et al.  Towards CT Enhanced Ultrasound Guidance for Off-pump Beating Heart Mitral Valve Repair , 2013, AE-CAI.

[12]  Ken Masamune,et al.  Augmented Reality Environments for Medical Imaging and Computer-Assisted Interventions , 2013, Lecture Notes in Computer Science.

[13]  Terry M. Peters,et al.  A Navigation Platform for Guidance of Beating Heart Transapical Mitral Valve Repair , 2013, IEEE Transactions on Biomedical Engineering.

[14]  J. Edwards,et al.  Ruptured Mitral Chordae Tendineae , 1961, Circulation.

[15]  C. Barrett,et al.  Mitral valve prolapse. , 1991, The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society.