Transesophageal echocardiography (TEE) has become indispensable in Cat-lab to guide some percutaneous interventions as a complimentary imaging for fluoroscopy. The tow imaging modalities are presented separately and differently making the interpretation of the anatomic spatial relationships not easy. Echonavigator® (Philips) software enables fusion between the two imaging modalities on the same screen. Few data on its feasibility and its clinical applications in children are currently available.

Assess the feasibility of Echonavigator system to guide interventional procedure in children with CHD, and to present our initial clinical experience using this software in pediatric Cat-lab.

We enrolled all children underwent interventional catheterization needing guidance by TEE from December 2015 to December 2017. Patients weighting less than 20 kg were excluded. TEE was realized using X7-2t TEE probe connected to an echocardiographic system (EPIC). Fluoroscopy was realized using Allura Xper FD/10 system. Image fusion was realized using Echnavigator system. Markers were positioned on the target zone on echocardiographic images and projected to the interventionists on the fusing screen.

Fifty-one patients with CHD were included, mean age was 8 years old (5.5–14), mean weight was 25 kg (20–36 kg). Thirty-six patients underwent ASD closure, 10 VSD closure, 3 aortic valve dilatation and 2 RVOT revaluations.

Image fusions were successfully obtained in all patients during all steps of procedure (Fig. 1). No complication related to TEE probe insertion or manipulation was observed. Markers were successfully positioned in the all target zones and automatically projected to the interventionist on the fusion screen.

Echonavigator system is feasible and safe to guide interventional catheterization in children with CHD. It enables better appreciation of anatomical relationships and improves confidence of interventionist to achieve the target zones.