New Perspectives in Cardiology

How to Save Materials, Time and Dose during Complex Cardiac Procedures


More than 10 years ago, Siemens Healthcare – now Siemens Healthineers – unveiled syngo DynaCT Cardiac, an innovative application that has revolutionized the workflow for complex cardiac interventions. Today at University Hospital Erlangen, the CT-like images generated by rotational angiography are increasingly being used for procedures such as non-surgical left atrial appendage (LAA) closure. With reliable 3D imaging of cardiac structures in real time, the intervention can be performed with fewer materials, in less time, and at a lower dose.

In recent years, cardiologists have focused increasingly on the left atrial appendage. In patients with atrial fibrillation, this protrusion of the left atrium has been identified as the place where blood clots are most likely to form. Such clots can ultimately lead to thromboembolism or stroke. As an alternative to drug treatment using anticoagulants, with their associated risks, the atrial appendage in suitable patients can be permanently closed by an implant inserted using a heart catheter.

Traditionally this procedure is supported by transesophageal echocardiography (TEE) and conventional fluoroscopy. However, since the resulting image quality can be impaired and TEE does not provide clear 3D visualization of the anatomy of the left atrial appendage, the use of 3D imaging during the procedure, with syngo DynaCT, has proved to be a valuable addition.

Precise measurement, lower dose
For Christian Schlundt, MD, senior consultant in cardiology and angiology at Erlangen University Hospital, the great benefit of using syngo DynaCT Cardiac for left atrial appendage closure is that it allows for precise 3D analysis and measurement of the cardiac anatomy. This means that the intervention can be both accelerated and made safer, as less contrast medium and a lower radiation dose are required. “The real advantage of using a DynaCT scan with these patients is that we get reliable data in real time. When we are selecting a device for closure of the atrial appendage, syngo DynaCT Cardiac provides us with the exact measurements
we need,” Schlundt explains.

Based on the revolutionary DynaCT technology, syngo DynaCT Cardiac uses rotational angiographic images to generate a 3D scan of the heart’s morphology, including the left atrium and the atrial appendage. It takes no more than five seconds to produce the scan, once contrast medium has been injected into the atrial appendage, and a further 20 seconds for the 3D reconstruction to be generated at the syngo X Workplace. “In my view, a DynaCT scan should be part of clinical routine, not just for closure of the left atrial appendage but also, perhaps, for closure of paravalvular leaks,” Schlundt argues. “By using syngo DynaCT Cardiac, we have been able to improve our clinical workflow, because the 3D scan helps us select the device we want to use more easily and with greater precision. We very often use syngo DynaCT Cardiac to do our sizing because it is so reliable and it makes it easier to choose the right implant for LAA occlusion. For example, today we need only one implant, not two or three as before, when we had to base our decision on the echocardiogram alone. That translates into a significant cost saving.”

High demand for less invasive procedures
As the population continues to age and the prevalence of heart disease increases, Schlundt expects to see high demand for cardiological interventions that place as little strain as possible on the patient. “I think that in many cases of structural heart disease we will be dealing with increasingly complex situations, involving older and older patients. Often we need all the information we can get about the heart we are treating.” That is exactly the sort of detailed information that syngo DynaCT Cardiac provides.

Treatment of Left Atrial Appendage
An 82-year-old patient with recur- 1A 1B rent large subcutaneous hematomas and suffusion bleeding due to oral anticoagulants prescribed for persistent atrial fibrillation. The patient was successfully treated by closure of the left atrial appendage.

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1Clinical images reproduced by kind permission of Markus Füller, MD, Georg von Bodman, MD, and Michael Block, MD, Augustinum Clinic, Munich, cardiology.

The statements by Siemens’ customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.