Advanced Protocol for Three-Dimensional Transesophageal Echocardiography Guidance Implementing Real-Time Multiplanar Reconstruction for Transcatheter Mitral Valve Repair by Direct Annuloplasty - 03/10/19
, Efthymios Sotiriou, MD a, Alexander R. Tamm, MD a, Tobias F. Ruf, MD a, Felix Kreidel, MD a, Yang Yang, MD b, Tilman Emrich, MD b, Andres Beiras-Fernandez, MD, PhD c, Tommaso Gori, MD, PhD a, d, Thomas Münzel, MD a, d, Eberhard Schulz, MD a, Ralph Stephan von Bardeleben, MD aAbstract |
Transcatheter direct annuloplasty has been introduced as a novel interventional treatment option for severe mitral valve regurgitation. Until now, only one direct annuloplasty device (Edwards Cardioband) has been commercially available, being implanted in more than 250 patients worldwide. Yet this procedure poses greater challenges regarding optimal fluoroscopic and echocardiographic guidance compared with edge-to-edge repair: correct localization and orientation of the anchors upon penetration into the fibrous mitral annulus tissue and the basal left ventricular myocardium are preconditions for an optimal result and essential to avoid damage of the neighboring structures (atrioventricular node, circumflex artery, coronary sinus). Real-time single-beat multiplanar reconstruction has become available as an additional imaging tool for three-dimensional transesophageal echocardiography in most recent echo machines. In this review, we introduce a three-dimensional transesophageal echocardiography–based imaging protocol implementing real-time multiplanar reconstruction for transcatheter direct annuloplasty procedures, which optimizes and also simplifies echocardiographic guidance during the implantation. The advanced echocardiographic protocol might also help to expedite implantation times and potentially increase the safety of the procedure. In this “how-to” article, we describe in detail this novel approach for optimized guidance and compare its advantages and challenges to “conventional” echocardiographic imaging for transcatheter mitral valve repair.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Multiplanar reconstruction (MPR) enables anatomically correct orientation in 3D-TEE. |
• | TMVR by direct annuloplasty poses challenges for TEE guidance. |
• | Echo guidance using real-time MPR for TMVR is feasible and might increase safety. |
• | Our “how-to” article presents a detailed MPR-augmented protocol for echo guidance. |
Keywords : 3D-TEE, Multiplanar reconstruction, Mitral valve regurgitation, Transcatheter mitral valve repair, Direct annuloplasty
Abbreviations : 2D, 3D, MPR, MR, TEE, TMVR
Plan
| Ralph Stephan von Bardeleben is a member of the advisory board to GE Healthcare, Philips Health Systems, Edwards Lifesciences. The other authors have no conflict of interest to declare. |
Vol 32 - N° 10
P. 1359-1365 - octobre 2019 Retour au numéro
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