Echocardiographic guidance in transcatheter structural cardiac interventions

Abstract

Catheter-based treatment of structural heart diseases (SHD) has seen tremendous advances in the past decades, thanks to the development of new devices and advances in imaging techniques. Today, we have an extensive armamentarium of imaging tools for preprocedural planning, intraprocedural guidance and follow-up of SHD. Intraprocedural guidance is based mainly on transoesophageal echocardiography; however, other imaging modalities are used as complementary or alternative techniques, each of them with its strengths and weaknesses. Thus, a multimodality imaging approach provides added values in this setting.

Complications of the Percutaneous Mitral Valve Edge-To-Edge Repair: Role of Transesophageal Echocardiography

“…Recently, the introduction of biplane images has facilitated the assessment of clip attachment due to the acquisition of simultaneous perpendicular views. Different authors have demonstrated that the additional use of 3D-TEE for the assessment of clip attachment may contribute to a reduced rate of subsequent clip complication [ 3 ]; therefore, the amount of both leaflets introduced into the clip must be assessed in a 3D enface view observing the amplitude of the inserted tissue and the formation of two pyramids whose vertex must be at least as wide as the clip ( Figure 4 ). Checking a precise rotation of the device by 3D-TEE to avoid asymmetric grasping is another important step to avoid this complication, and, in addition, multiple leaflet grasps may lead to leaflet injury and should be avoided if possible.…”

“…Transesophageal echocardiography (TEE) plays a fundamental role in minimizing the risk of procedural complications, as well as in their early detection [ 3 ]. Some authors have also demonstrated the superiority of real-time 3-D transesophageal echocardiography (3D-TEE) not only in mitral clip guidance but also in the early detection of complications [ 4 ].…”

Imaging in transcatheter native mitral valve replacement with Tendyne mitral valve system: Echocardiographic pathway for the interventional imager

“…This growth has been possible thanks to the developments and rapid progress of new percutaneous devices but also due to the innovations in imaging techniques [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. These developments have prompted the need for a new dedicated professional figure with specific competencies in the field of structural heart disease procedures imaging 'the interventional imager' whose collaboration with the implanter team is crucial for the procedural success [22,25,26].…”

“…Imaging is paramount in planning and guide the MV interventional procedure. While the angiography and the fluoroscopy are performed by the implanter team, other multimodality imaging, semi and non-invasive, the so called 'interventional imaging', is performed by the structural heart disease interventional imagers [16][17][18][19][20][21][22]25,26]. A peculiar imaging work-up is essential to select the right patient [16][17][18][19][20][21][22]25,26].…”

Virtual reality in cardiac interventions—New tools or new toys?

“…What sounds a little strange at first glance makes perfect sense for a few reasons: Cardiac imaging has become an important part of procedure planning in cardiovascular medicine, especially for structural heart but also coronary artery disease 1,2 . Image modalities that play a crucial role in this context are cardiac computed tomography (CCT), 3 echocardiography 4–6 and cardiac magnetic resonance imaging 7 . Each modality has its own advantages and disadvantages.…”