Rapid pacing rotational angiography with three-dimensional reconstruction: use and benefits in structural heart disease interventions

High quality three-dimensional imaging is one of the cornerstones in structural heart disease interventions. Current mainstream technology to acquire three-dimensional imaging utilises computed tomography or magnetic resonance imaging. Incorporation of these data with conventional angiographic images may not be sufficient. We describe a new imaging technique consisting of rotational angiography combined with rapid pacing to obtain real-time, high-quality, three-dimensional images in the catheterisation laboratory.Rotational angiography is performed with breath holding and rapid pacing on a large format digital flat-panel angiographic system. During a 200 degrees rotation, 150 angiographic images are acquired in five seconds and automatically reconstructed in less than 30 seconds. This imaging technique was used in six patients (mean age 32 +/- 10 years) to guide structural heart disease interventions. No complications were associated with rapid pacing. This imaging technique allowed acquisition of high-quality, three-dimensional images with a low volume of contrast media. Volume renderings helped appreciation of the lesions and optimisation of the working views. Multiplanar visualisation allowed true orthogonal measurements of vascular diameter during the procedures.The advantages of this imaging technique include rapid image acquisition and precise imaging of complex structures using low volume of contrast media.