Interventional Pediatrics

Imaging can be life-saving, and GE Healthcare is committed to offering dedicated pediatric protocols that provide high image quality with lower dose to help provide exceptional care for young patients.

Overview

Minimally invasive procedures are generally less risky and less painful for children than open surgery.

Children tend to have less discomfort after the procedures, which can shorten hospital stays and require less nursing care. Recovery time is also likely to be shorter.

Since most minimally invasive procedures require only very small incisions, no stitches are needed, and there is usually less scarring. Minimally invasive procedures normally cost less, as well.  Many techniques applied to adults can generally be performed in children, though the indications may differ.

Even when a minimally invasive intervention seems to be the better choice, clinicians must remember that children are more sensitive to radiation. The Image Gently Alliance encourages clinicians to use caution with dose and adapt diagnostic imaging protocols when working with children. Visit the Image Gently website¹.

Children are different than adults, so imaging solutions must be adapted to get high-quality diagnosis and procedure guidance while managing radiation dose. GE Healthcare’s solution address three key challenges of pediatric interventional cardiology:

  • Image Quality and Dose
  • Congenital Anatomy
  • Pediatric Hemodynamics

Benefits

Adapt your diagnostic imaging protocols when working with children.

The younger the patients, the more sensitive they are to radiation. Children have a long life expectancy, and that increases their chance of developing cancer over time. Children may also have to undergo repeated procedures throughout their life, contributing to a higher cumulative dose.

Use advanced applications to visualize congenital defects.

Congenital heart disease can be challenging to treat because it includes many structural anomalies and deformities. There are many ways in which the heart can be defective - and be repaired. Congenital anomalies involve defects in or damage to a developing fetus and often involve the heart chambers or large vessels. Understanding the defects often requires a 3D view of the anatomy.

Measure pediatric hemodynamic with dedicated software.

Measuring hemodynamic in pediatric patients is challenging because of the wide spectrum of age, size, and weight. Hemodynamic is significantly different in children than in adults, either because of the immaturity of the cardiac muscle or because the arterial pressure is simply lower. GE Healthcare’s solutions for recording pediatric hemodynamic includes the Mac-Lab Hemodynamic Recording System and the optional PedCath7² software integration.

Imaging Protocols

Dedicated imaging pediatric protocols.

GE Healthcare developed dedicated pediatric protocols to provide high image quality helping clinicians to reach a dose as low as reasonably achievable. It includes two dedicated pediatric cardiac protocol (neonate and non-neonate) to optimize dose and IQ settings. Those protocols are set-up with a default low dose setting and a forced 0.1 copper filtration for dose reduction. It is set-up at 30fps frame rate for high temporal resolution with an additional pulse width reduction feature for sharp capture of the fast-moving heart. At any-time the user can change those settings from the table-side to reach lower dose levels or increase the image quality for a couple of shots.

Cumulative dose calculation over time.

A specific pediatric setup is available in GE Healthcare’s Dose Map to help you track dose to your pediatric patients. Dose Map records and displays the estimated local cumulative dose during procedures performed on GE Healthcare angiographic systems. The calculation and cumulative local dose are displayed upon request or when a configured threshold is reached. You can visualize the local cumulative dose distribution as well as the projection of the beam during the exam.

DoseWatch

GE Healthcare’s DoseWatch also helps you improve patient care by understanding each patient’s cumulative exposure, identifying sources of variability, comparing and contrasting dose by protocol or exam. It captures, tracks and reports radiation dose directly from any DICOM imaging device or PACS across multiple modalities and manufacturers. DoseWatch helps radiologists deliver the right dose, while still producing quality images. By tracking patients’ cumulative dose over time, you can take steps to prevent excessive medical radiation exposure.

Advanced Applications

Pre-operative datasets to reconstruct the anatomy.

Pre-operative CT or MRI datasets can be prepared on the AW workstation using dedicated post-processing tools to display, reformat, and analyze 2D or 3D cardiac images for qualitative or quantitative assessment of heart anatomy and coronary arteries from a single or multiple cardiac phase image dataset. This requires only few minutes to plan from the pre-operative datasets using 0-click bone removal and vessel tracking.
 

In-room 3D acquisition for live anatomical visualization.

The pediatric patients can benefit of the dose saving brought by the Innova 3D which reconstructs 3D volumes from rotational angiography using less contrast agent compared to the radiation required to get the same level of anatomical detail for patients using 2D angiograms. Innova 3D aids in diagnosis, surgical planning, interventional procedure guidance, and follow-up. It can be used at any time during the procedure to give better visualization and hands-on 3D assessment of complex anatomy in their natural 3D state.
 

3D road-mapping for device guidance.

Pre-operative datasets or in-room 3D acquisitions can be used to overlay on live fluoroscopic images. The planning 3D images can be used to find the optimal angulation for imaging the anatomy of interest in the correct projection during the procedure. The resulting 3D image can be overlaid in a single-click through Innova HeartVision to help guide devices with confidence in complex anatomies. This 3D road-mapping provides a live 3D status of where the clinician stands with devices in complex anatomical structures.

Hemodynamic

Mac-Lab Hemodynamic Recording System.

Mac-Lab is a powerful hemodynamic recording system that is able to collect data consistently and accurately from the time the patient enters the holding room, through the procedure to recovery. It provides measurement tools including advanced pediatric measurement algorithms for the most demanding patients.

The mean arterial pressure, the most reliable parameter in children under 6 years old, is accurately measured with a heart rate up to 200 bpm. Blood pressure is measured with a dedicated pediatric Noninvasive Blood Pressure Amplifier (NIBP) algorithm. The high-quality cardiac output is measured with four VO2 calculations from the Fick principle and LaFarge equations dedicated to pediatric patients.

PedCath7 software integration.

PedCath7 integration automatically transfers information from MacLab to PedCath. It integrates The Mullins & Mayer Congenital Heart Disease, A Diagrammatic Atlas, the industry standard diagrammatic atlas, with 160 images of congenital heart disease in a simple yet elegant style. It can be directly accessed from the Mac-Lab without the need for a dedicated computer or screen in the room.

Procedures

Pulmonary artery valve replacement with Innova HeartVision

Transcatheter pulmonary valve procedures provide a minimally-invasive means to extend the life of a failed RVOT conduit by allowing physicians to deliver a replacement pulmonary valve. The Melody³ Transcatheter Pulmonary Valve (TPV) is a heart valve attached to a stent that functions as an artificial pulmonary valve for patients with failed pulmonary valve conduits. The catheter is inserted into a vein in the leg and guided up to the heart. The stent, which expands with the help of balloons, delivers the heart valve so that blood can flow better.

Plan

Guide

Assess

HeartVision provides the optimal C-arm angulation for valve deployment with CT or Innova 3D. Pulmonary artery conduit quantitative sizing and calcification visualization provide critical information for angioplasty and valve deployment.

HeartVision helps navigate complex and unusual anatomies with confidence & helps avoid coronary compression during angioplasty and valve deployment. Fused fluoroscopic images obtained with Innova Vision provides visual guidance during deployment of the valve.

Innova 3D can help assess positioning
of the Melody³ Valve.

Pulmonary Artery Valve Replacement with Innova 3D

Transcatheter pulmonary valve procedures provide a minimally-invasive means to extend the life of a failed RVOT conduit by allowing physicians to deliver a replacement pulmonary valve. The Melody³ Transcatheter Pulmonary Valve (TPV) is a heart valve attached to a stent that functions as an artificial pulmonary valve for patients with failed pulmonary valve conduits. The catheter is inserted into a vein in the leg and guided up to the heart. The stent, which expands with the help of balloons, delivers the heart valve so that blood can flow better.

Plan

Guide

Assess

Innova 3D reconstructed images clearly revealed a narrowing in the conduit from the right ventricle to the pulmonary artery and located the narrowing in the distal portion of the conduit.

Online 3D acquisition during the procedure helps view the balloon position in relation to coronaries.

A post-procedure Innova 3D was
acquired. The imaging showed that the valve was positioned accurately. Absence of contrast reflux helped the clinician
confirm that the valve was competent.

Aortic coarctation with Innova HeartVision

Aortic coarctation demands meticulous, detailed planning. Precise guidance and device positioning are crucial. With 3D rotational angiography and HeartVision, you can plan and guide challenging procedures with confidence.

Plan

Guide

Assess

Innova 3D provides quantitative measurement of the vessel narrowing and helps clinicians find the optimal C-arm angulation.

Innova HeartVision fuses the 3D image on   the live fluoroscopy to guide serial angioplasty on the aortic coarctation.

With Innova 3D compares pre- and
post-angioplasty vessel size.


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Disclaimer

1. The Image Gently web site is solely responsible for its content and by providing this link to the Image Gently website GE Healthcare is not endorsing nor takes responsibility for or gives any guaranty to the validity of its content and has no affiliation with or to the Image Gently web site or content.

2. PedCath7 is not available in all markets.

3. GEHC is not responsible for the licensing or registration or sale of this device. This device may not be available in all markets. In US, this device is under HDE (Humanitary Device Exemption). Please contact the manufacturer for more information.

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