{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:33:25Z","timestamp":1715582005142},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2007,8,30]],"date-time":"2007-08-30T00:00:00Z","timestamp":1188432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Robotics Computer Surgery"],"published-print":{"date-parts":[[2007,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prenatal cardiac interventions (PCI) for human fetal aortic valve (AoV) stenosis can reduce left ventricular hypoplasia and restore ventricular growth and function. However, \u2018freehand\u2019 needle delivery from the maternal skin through the uterine wall, fetal chest and ventricular apex to cross the fetal AoV remains technically challenging and time intensive, and is the rate\u2010limiting step in the procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed a computer\u2010assisted navigation (CANav) system that tracks the position and orientation of a two\u2010dimensional (2D) ultrasound image relative to the trajectory of an electromagnetic (EM) embedded needle and stylet. We tested the CANav system <jats:italic>in vitro<\/jats:italic> using a water bath phantom, then <jats:italic>in vivo<\/jats:italic> using adult rats and pregnant (fetal) sheep.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The CANav system accurately tracked the delivered needle position in both <jats:italic>in vitro<\/jats:italic> phantom and adult rat model experiments. We performed 22 PCI attempts with or without CANav in a fetal sheep model. Maternal laparotomy was required to adjust the fetal position in 50% of the procedures. The time required to deliver the needle from the skin into the left ventricle (LV) using CANav was 2.9 \u00b1 1.7 (range 2\u20137) min (<jats:italic>n<\/jats:italic> = 14) vs. 5.5 \u00b1 4.3 (range 1\u201312) min (<jats:italic>n<\/jats:italic> = 8) without CANav (<jats:italic>p<\/jats:italic> &lt; 0.05). The time needed to cross the aortic valve once the needle was within the LV was similar with and without CANav (<jats:italic>p<\/jats:italic> = 0.19).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CANav reduces the PCI time required to accurately deliver a needle to the fetal heart. Adaptations of this technical approach may be relevant to other congenital cardiac conditions and ultrasound\u2010guided medical procedures. Copyright \u00a9 2007 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/rcs.145","type":"journal-article","created":{"date-parts":[[2007,8,30]],"date-time":"2007-08-30T09:46:38Z","timestamp":1188467198000},"page":"187-198","source":"Crossref","is-referenced-by-count":11,"title":["Computer\u2010assisted navigation applied to fetal cardiac intervention"],"prefix":"10.1002","volume":"3","author":[{"given":"Stephen P.","family":"Emery","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Kreutzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick R.","family":"Sherman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuro 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