interventionalec hoc ard iographyin s tru c tu ralh ...3d tee –ideal tool to guide structural...
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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