InterventionalEc hoc ard iographyin S tru c tu ralH ...3D TEE –ideal tool to guide structural...

InterventionalEc hoc ard iography inS tru c tu ralH eartD is eas e

C atalin L oghin, M DC atalin L oghin, M D

N O D IS C L O S URES

C atalin L oghin, M D

P as tand P res ent

M iller M M etal. ; Interac tC ard ioVasc Thorac S u rg; 2008 ; 7 : 1 167 -1169M ad d erRD etal; JA C C C ard Interv; 2011 ; 1 ; 4; 7

3D TEE –ideal tool to guide structural heart interventions

• 3D pyramid al, s ingle beatd atas et

• Realtime d is play

• D is plays “s u rgeon’ s view”

• D iagnos tic temporaland s patialres olu tion

• D etailed anatomy• D etailed anatomy

• Fu llhemod ynamic d ata

• Follows the patient

3D TEE –role in every step of patient care

• D IA GN O S TIC

• S malls tru c tu res : flails c allops , s eptalrims , fenes trated perivalvu larleaks

• D ynamic s tru c tu res : regu rgitant/s tenotic orific es , annu li, d efec ts

• P L A N N IN G:

• P roc ed u rals trategy: hybrid , s taged approac h –c onventionalvs . minithorac otomy, andperc u taneou s interventions

• P roc ed u ralplanning /d evic e c hoic e : patients pec ific 3D printing

• IN TERVEN TIO N :• IN TERVEN TIO N :

• Realtime proc ed u ralgu id anc e

• Rapid id entific ation ofproc ed u ralc omplic ations

• FO L L O W -UP :• FO L L O W -UP :

• L ow ris k, s emiinvas ive proc ed u re

M . B ramlet–C irc u lation 20 14; 130 ; A 2 0 614

3D TEE –limitations

• H ighly operatord epend ent

• N o s tand ard ized ac q u is ition protoc ol

• O peratorexpos u re to rad iation

• L imited available expertis e

• M any mis lead ing artifac ts• M any mis lead ing artifac ts

• P os tproc es s ing time c ons u ming

2D TEE –transseptal puncture

• 2 D preferred , 3D c an mis lead

• O rthogonalviews ; axial(4C )and s agittal(“s hortaxis atthe bas e”)• O rthogonalviews ; axial(4C )and s agittal(“s hortaxis atthe bas e”)

• C hoic e ofpu nc tu re s ite d ic tated by targets tru c tu re

• C ritic als tep-affec ts the whole proc ed u re• C ritic als tep-affec ts the whole proc ed u re

3D TEE –S u rgeon’ s view

AV T V

AM curtain

AM L

P M L

L AAL U P V R A

Realtime 3D TEE

3D TEE -VA L VE M O D EL IN G

3D TEE –es tablis hed role

T AVR

M itraC lip®

L AA occluders

P erivalvularleaks

3D TEE -TA VR

S iemens –L . S u gengM D

A ortic valve –2D vs 3D TEE

TA VR d eployment

S apien XT

C T vs 3D TEE

- 3D TEE u nd eres timates vs . C T- Exc eption: s agittalC T views

H u s s erO etal; Intern JC ard , 2 0 13S agittal C oronal A rea

TEE : 2D or3D ?

O peratord epend ent!

TEE d riven TA VR

2D and 3D TEE ac c u rate for A nnu lu s s izing P V L pred ic tion and evalu ation

H an R etal; JA S E , 2 0 13, 26, 9

C oreValve

3D TEE –mitralvalve

S iemens –L . S u gengM D

D egenerative M R

M itraC lip®

Fu nc tionalM R –“zipper”proc ed u re

Fu nc tionalM R -pos t

P erivalvu larregu rgitation

P erivalvu larregu rgitation

L A A oc c lu s ion

W atc hman

L A A oc c lu s ion

W atc hman