Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging

Abstract

Percutaneous interventions have completely refashioned the management of children with congenital heart diseases (CHD) and the use of non-invasive imaging has become the gold standard to plan and guide these procedures in the modern era. We are now facing a dual challenge to improve the standard of care in low-risk patients, and to shift our strategies from the classic open chest surgery to imaging-guided percutaneous interventions in high-risk patients. Such rapid evolution of ultrasound technologies over the last 20 years have permitted the integration of transthoracic, transesophageal and intracardiac echocardiography into the interventional workflow to improve image guidance and reduce radiation burden from fluoroscopy and angiography. Specifically, miniaturization of transesophageal probe and advances in three-dimensional (3D) imaging techniques have enabled real-time 3D image guidance during complex interventional procedure, In addition, multimodality and fusion imaging techniques harness the strengths of different modalities to enhance understanding of anatomical and spatial relationship between different structures, improving communication and coordination between interventionalists and imaging specialists. In this review, we aim to provide an overview of 3D imaging modalities and multimodal fusion in procedural planning and live guidance of percutaneous interventions. At the present times, 3D imaging can no longer be considered a luxury but a routine clinical tool to improve procedural success and patient outcomes.

Role of Cardiovascular Imaging in the Follow-Up of Patients with Fontan Circulation

“…Two-dimensional echocardiography remains the first-line imaging to assess the patency of the Fontan circuit, single-ventricle and valves’ function, and aortic outflow obstruction [ 10 ]. The use of deformation imaging and 3D echocardiography in Fontan patients is still not fully integrated in routine clinical practice, but data are emerging about their potential role in the evaluation of single-ventricle performance [ 70 , 71 ], valve morphology and function [ 72 ], and to guide interventional procedures [ 73 ] in specialised centres. Echocardiography should be performed at least annually and, considering that patients are often the best controls of themselves, it is useful to compare their functional parameters over the years.…”

Current status of transcatheter intervention for complex right ventricular outflow tract abnormalities

“…Three-dimensional rotational angiography (3DRA) is useful for better visualization of RVOT morphology, CA or aortic compression during the balloon dilation test. Despite concerns about increased radiation exposure with 3DRA, it has been reported that the total radiation dose is no different to conventional bi-plane angiography 84,85 .…”