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Updated: May 5, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Integrated x-ray and echocardiography imaging for structural heart interventions
Roberto Corti1, Patric Biaggi, Oliver Gaemperli
1HeartClinic Hirslanden, Klinik Hirslanden, Zurich, Switzerland.
Insights
Treating structural heart disease (SHD) percutaneously is challenging due to imaging limitations. Fusing 3D transesophageal echocardiography (TEE) with live X-ray offers improved visualization and procedural efficiency for interventional cardiologists.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Technology Innovation
Background:
- Percutaneous treatment of structural heart disease (SHD) is increasing but faces challenges.
- Current imaging modalities, primarily fluoroscopy, limit simultaneous visualization of anatomy and devices.
- 3D transesophageal echocardiography (TEE) offers soft tissue insights but visualization challenges persist.
Purpose of the Study:
- To address the limitations of visualizing cardiac anatomy and devices during percutaneous SHD interventions.
- To explore the potential of fusing live 3D TEE with live X-ray for improved procedural guidance.
- To enhance communication, confidence, and efficiency in SHD interventions.
Main Methods:
- Review of current imaging technologies for SHD interventions.
- Discussion of the challenges in visualizing soft tissue anatomy and device interaction.
- Proposal of an innovative imaging technology integrating live 3D TEE and live X-ray.
Main Results:
- Inability to simultaneously visualize anatomy and devices is a key difficulty in SHD interventions.
- 3D TEE provides valuable soft tissue anatomical information.
- Fusion of live 3D TEE and live X-ray is proposed as a solution to improve visualization and guidance.
Conclusions:
- Improved visualization is critical for the success of percutaneous SHD treatments.
- Integrated imaging technologies like fused live 3D TEE and X-ray can enhance operator confidence and anatomical awareness.
- This innovative approach has the potential to increase procedural efficiency and success rates in SHD interventions.
Abstract:
Treatment of structural heart disease (SHD) represents a growing need and, with increasing device availability, an increasing number of SHD can be and will be treated percutaneously. However, interventional treatment of SHD is challenging. Long procedure times and steep learning curves are recognised obstacles. The main difficulties arise, however, from the inability to visualise simultaneously the anatomy and the devices using a single imaging technology. In fact, the majority of percutaneous interventions in SHD are guided by fluoroscopy. On the other hand, a multitude of imaging technologies are presently available to guide the interventionalist. Of these technologies, transoesophageal echocardiography (TEE), and particularly 3-D TEE, is rapidly becoming the imaging modality of choice for many of these procedures because it provides critical insights into soft tissue anatomy. However, adequate visualisation and appreciation of the relationships between the cardiac structures and the devices using various imaging modalities remain a challenge. Hence, the interaction between the operator and imager is a crucial factor in attaining procedural success. Innovative technology that fuses live 3-D TEE with live x-ray in an intuitive way could have an important added value. This new imaging technology seeks to improve the communication between the echocardiographer and the interventionalist, to increase the confidence and anatomical awareness, to assist in guidance, and to increase procedural efficiency.
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