Image – Interventional flashlight

DOI: 10.4244/EIJ-D-20-00649

Computed tomography-derived transoesophageal echocardiographic views for preprocedural planning of direct transcatheter mitral valve annuloplasty

Federico Fortuni1,2, MD; Frank van der Kley1, MD; Nina Ajmone Marsan1, MD, PhD; Victoria Delgado1, MD, PhD

Figure 1. CT-derived transoesophageal echocardiographic views for direct transcatheter mitral valve annuloplasty. A) The virtual TEE probe (black arrow) placed in the oesophagus and gastric fundus on the sagittal MDCT view and predicted fluoroscopy view. On the right side are shown the settings (green box) that can be adjusted to derive TEE views from MDCT data. The ideal MDCT-derived TEE views can be obtained and reproduced during the procedure to guide the catheter (white arrow) and place the anchors in the predicted position (B-D). E) The reduction of mitral regurgitation grade from severe (upper image) to moderate (lower image) after successful transcatheter mitral valve annuloplasty with the Cardioband system, size D. Ao: aorta; LA: left atrium; LV: left ventricle

Multidetector row computer tomography (MDCT) and transoesophageal echocardiography (TEE) are the imaging modalities of choice for patient selection and planning of transcatheter valvular interventions1. For transcatheter mitral valve annuloplasty with the Cardioband™ system (Edwards Lifesciences, Irvine, CA, USA), high spatial resolution data from MDCT are required for accurate measurement of the mitral valve annulus (MVA) to select the device size and for assessment of the distance between MVA and circumflex artery to ensure safe implantation of the anchors of the device1. TEE is key to assess the mechanism and severity of mitral regurgitation. However, TEE has lower spatial resolution compared with MDCT and, in some patients, it might be difficult to image the location where the anchors of the Cardioband system should be placed. A dedicated software (3mensio; Pie Medical Imaging BV, Maastricht, the Netherlands) for post-processing MDCT data allows reproducing TEE views which may be compared to the TEE images needed for procedural guidance (Figure 1A-Figure 1D). This novel feature can be used for teaching purposes and may provide several advantages in the imaging key steps to guide transcatheter mitral valve annuloplasty. Specifically, it may help to identify the best TEE views for transseptal puncture and to image the predefined MDCT anchoring sites of the device, potentially allowing faster and better alignment of the anchors during the procedure. The virtual TEE probe (Figure 1A, black arrow) can be placed in the oesophagus and its angulation and anteflexion or retroflexion can be adjusted to obtain the desired MDCT-derived TEE view (green box). The software also allows visualisation of the height of the probe on the predicted fluoroscopic views that could be challenging to reproduce during the procedure. We present the case of a 66-year-old patient with ischaemic severe mitral regurgitation and New York Heart Association (NYHA) Class III heart failure symptoms who underwent transcatheter mitral valve annuloplasty due to high operative risk. In the preoperative TEE evaluation, the imaging of the posterolateral MVA was particularly challenging. The MDCT-derived TEE views helped to identify the best TEE images to guide the catheter (Figure 1B-Figure 1D, white arrow) during the procedure. The procedure was successful with a significant reduction in the annular diameters and mitral regurgitation (Figure 1E), accompanied by an improvement in heart failure symptoms (NYHA Class I).

Funding

The Department of Cardiology of the Leiden University Medical Center received research grants from Abbott Vascular, Bayer, BioVentrix, Medtronic, Biotronik, Boston Scientific, GE Healthcare and Edwards Lifesciences.

Conflict of interest statement

N. Ajmone Marsan reports speaker fees from Abbott Vascular. V. Delgado reports personal fees from Abbott Vascular, MSD, Novartis, Edwards Lifesciences, Medtronic, and GE Healthcare. The other authors have no conflicts of interest to declare.

Supplementary data

To read the full content of this article, please download the PDF.

Volume 17 Number 2
Jun 11, 2021
Volume 17 Number 2
View full issue


Key metrics

Suggested by Cory

TECHNICAL REPORT

10.4244/EIJV11I12A273 Mar 18, 2016
Computed tomography optimised fluoroscopy guidance for transcatheter mitral therapies
Van Mieghem NM et al
free

10.4244/EIJV10I7A151 Nov 20, 2014
How should I treat a challenging case of MitraClip implantation?
Duino V et al
free

EXPERT REVIEW

10.4244/EIJ-D-18-00614 Sep 7, 2018
Multimodality imaging for interventional cardiologists
Pighi M et al
free

EXPERT REVIEW

10.4244/EIJ-D-17-00516 Sep 24, 2017
Imaging for structural heart procedures: focus on computed tomography
Mooney J et al
free

10.4244/EIJV12SYA2 Sep 18, 2016
Integrated imaging: a new skill for interventional cardiologists
Delgado V and Bax J
free

State-of-the-Art

10.4244/EIJ-D-22-00725 Jan 23, 2023
Mitral valve transcatheter edge-to-edge repair
Hausleiter J et al
free
Trending articles
151.43

State-of-the-Art

10.4244/EIJ-D-22-00776 Apr 3, 2023
Computed tomographic angiography in coronary artery disease
Serruys PW et al
free
55.9

Clinical research

10.4244/EIJ-D-22-00621 Feb 20, 2023
Long-term changes in coronary physiology after aortic valve replacement
Sabbah M et al
free
54.9

Expert review

10.4244/EIJ-D-21-01010 Jun 24, 2022
Device-related thrombus following left atrial appendage occlusion
Simard T et al
free
43.75

Clinical Research

10.4244/EIJ-D-21-01091 Aug 5, 2022
Lifetime management of patients with symptomatic severe aortic stenosis: a computed tomography simulation study
Medranda G et al
free
39.95

Clinical research

10.4244/EIJ-D-22-00558 Feb 6, 2023
Permanent pacemaker implantation and left bundle branch block with self-expanding valves – a SCOPE 2 subanalysis
Pellegrini C et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 7.6
2023 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2024)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved