Accurate procedural guidance is necessary for structural heart disease (SHD) interventions to reduce procedural times and improve results. Fluoroscopy remains the foundation imaging modality for guidance of transcatheter therapy. However, fluoroscopy has limitations in that it only provides 2D projections of complex 3D anatomy. Fusion technology has the capability to project cardiac imaging, including echocardiography and computed tomography (CT), onto fluoroscopy for a more complete representation of the anatomy to help guide SHD interventions. This in turn allows for a more effective workflow that may improve safety and efficacy while decreasing procedural times, radiation exposure, and contrast dosage. This review focuses on the use of fusion imaging for SHD interventions.

Recent studies support the feasibility of fusion imaging for a variety of SHD interventions. The impact of fusion imaging on operator confidence, procedural success rates, and outcome measures, such as procedure time and radiation exposure, are currently being evaluated.

The use of echocardiography-fluoroscopy and computed tomography angiography (CTA)-fluoroscopy fusion imaging has been established for a multitude of SHD interventions. While fusion imaging has the potential to improve SHD interventions, data is mainly limited to observational studies. Therefore, future studies are needed to evaluate if fusion imaging leads to an improvement in procedural success and a reduction in procedural time, radiation exposure, and contrast dose.