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Echocardiography in Transcatheter Structural Heart Disease Interventions
Hiren Patel1, Ajit Raisinghani2, Anthony DeMaria2
1Division of Cardiology Program, University of California San Diego, San Diego, CA, United States of America.
Insights
Interventional echocardiography guides complex structural heart disease (SHD) procedures. Advanced imaging, particularly 3D transesophageal echocardiography, is vital for successful percutaneous interventions and patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Procedures
Background:
- Structural heart disease (SHD) interventions are expanding, requiring precise guidance.
- Percutaneous SHD procedures involve complex catheter navigation within the heart and great vessels.
- 3-dimensional imaging is critical for guiding these free-moving catheters.
Purpose of the Study:
- To review the pivotal role of echocardiography in guiding percutaneous structural heart disease interventions.
- To highlight the importance of the echocardiographer's expertise in these complex procedures.
Main Methods:
- Focus on echocardiography, particularly 3D transesophageal echocardiography (TEE).
- Review of imaging guidance across the spectrum of SHD interventions.
- Emphasis on the echocardiographer's knowledge of instrumentation, anatomy, procedures, and complications.
Main Results:
- Echocardiography is essential throughout percutaneous interventions, from patient selection to device assessment.
- 3D TEE provides crucial real-time imaging for complex catheter manipulation.
- Skilled echocardiographers are indispensable for successful procedural outcomes.
Conclusions:
- Echocardiography, especially 3D TEE, is fundamental to the success of interventional structural heart disease procedures.
- The expertise of the echocardiographer is paramount for safe and effective transcatheter guidance.
Abstract:
Interventional echocardiography is an emerging field with growing interest and applications as therapeutic procedures to address structural heart disease (SHD) continue to evolve and expand. As opposed to coronary interventions, in which the course of catheter movement is constrained within the artery, percutaneous procedures for SHD entail free catheter movement within the heart and great vessels. Imaging guidance in 3-dimensional space is therefore of critical importance to the successful performance of these procedures. The complexity of these procedures requires an imager with a complete knowledge of ultrasound instrumentation and technique, an in-depth knowledge of cardiac anatomy, understanding of the procedural steps involved, and an awareness of potential complications that may arise perioperatively. Echocardiography, especially 3-dimensional transesophageal echocardiography, plays a crucial role in every aspect of percutaneous interventions, from patient selection to final device assessment. This review will focus on the role of echocardiography and the echocardiographer with respect to transcatheter guidance for the spectrum of SHD interventions that have gained worldwide application in recent years.
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