Fig. 4.

X-Ray Fused with MRI (XFM) Guidance of Percutaneous Pulmonary Valve Implantation. a Demonstrates three-dimensional (3D) reconstruction of the right ventricular outflow tract and proximal branch pulmonary arteries (blue). Multiple imaging slices of that region of interest are shown in the vertical panel. b–d demonstrate critical structures depicted by CMR with overlay on live X-Ray fluoroscopy. Three purple rings (most posterior in c, d) show main trachea and right, left bronchus. Blue ring shows proximal right ventricular outflow tract. Green and yellow rings show proximal right and left pulmonary artery, respectively. Large purple circle in c, d highlights intended landing zone. b Shows soft-tissue CMR contour of aorta and pulmonary artery circulation as well as a venous catheter advanced to the right pulmonary artery. c Shows implantation of a percutaneous pulmonary valve. Rigid guidewires displace anatomy making XFM less accurate (see wire in left pulmonary artery above yellow or left pulmonary artery ring). d Shows percutaneous pulmonary valve after implantation and removal of rigid guidewire restoring XFM accuracy. Co-registration was performed with trachea, bronchus, and spine markers. Images are courtesy Dr. Sebastian Goreczny [Polish Mother’s Memorial Hospital, Research Institute (Lodz, Poland) and Children’s Hospital Colorado (Aurora, CO)] [60]