Computer Assisted Surgery Prenatal Cardiac Intervention

描述(由申请人提供)： 大约1%的新生儿需要手术治疗先天性心脏病。在世界范围内，每年有8万例儿童心脏手术。这些手术都是在出生后进行的。然而，基于越来越多的人认识到早期解剖修复有利于儿童的健康，产前心脏干预(PCI)虽然是革命性的，但对于纠正主动脉瓣狭窄和其他导致左心发育不全综合征(HLHS)的异常是非常可取的。与此同时，可用于PCI的技术显然是不足的。 我们的建议是开始一项多阶段的努力，以实现技术和介入性技术，使其有可能在胎儿处于母亲的子宫内时对其进行非常微妙和复杂的心脏手术，即使用宫内微创技术。总体概念是提供干预主义的图形显示、导航辅助和体内传感功能，以实现经皮冠状动脉介入治疗并确认其有效性。我们方法的实质是对目前用于经皮冠状动脉介入治疗的设备和装置进行微小的扩充，但这样做是为了显著增加提供给干预者的信息内容。 本文提出的具体研究是为介入治疗中使用的仪器开发一种光学位置跟踪解决方案，使其能够高精度和实时地测量它们的相对位置。基于这些数据，将容易地创建结合超声图像和导航数据的图形显示。有了这种实时显示，干预者将有办法可视化导管和引导器的确切位置，即使它们在超声图像中不明显。此外，显示器将显示其他显著的几何特征，例如导管进一步插入时将遵循的轨迹，以及该工具路径和超声图像之间的距离和角度。原型系统将基于我们为矫形外科开发的三项技术。 这项研究将与卡内基梅隆大学的机器人研究所和匹兹堡儿童医院的心脏科合作进行。在第二阶段，我们将在适当的动物模型中对传感器进行体内测试。

DESCRIPTION (provided by applicant): Approximately 1% of babies born require operative treatment for congenital heart diseases. Worldwide, 80,000 pediatric cardiac procedures are performed annually. These procedures are all performed postnatally. However, based on a growing recognition that earlier anatomic repair is beneficial to the health of the child, it has become clear that prenatal cardiac intervention (PCI), though revolutionary, is highly desirable to correct aortic valve stenoses and other abnormalities that lead to hypoplastic left heart syndrome (HLHS). At the same time the technology available for PCI is clearly deficient. Ours is a proposal to begin a multi-phase effort to realize technologies and interventional techniques that will make it possible to perform extraordinarily delicate and intricate cardiac procedures on a fetus while it is in the mother's womb, i.e., using minimally invasive in utero techniques. The overall concept is to provide the interventionalist graphical displays, navigation aids and in vivo sensing capabilities that enable a PCI and confirm its efficacy. The essence of our approach is to make minor augmentations of the equipment and devices currently used for PCI, but in so doing to make a significant increase in the information content provided to the interventionalist. The specific research proposed here is to develop an optical position tracking solution for instruments used in PCI that will enable their relative locations to be measured with high accuracy and in real time. Based on those data, a graphical display that combines ultrasound imagery and navigation data will readily created. With this real time display, the interventionalist will have the means to visualize the exact location of catheters and introducers even if they not clearly evident in the ultrasound images. Further, the display will show other salient geometric features, such as the trajectory a catheter will follow if it is inserted further and distances and angles between that tool path and the ultrasound image. The prototype system will be based on three technologies we have developed for orthopaedic surgery. This research will be conducted in partnership with Carnegie Mellon University's Robotics Institute and the Cardiology Department of Children's Hospital of Pittsburgh. In Phase Two, we will conduct in vivo tests of the sensors in appropriate animal models.