Fusion imaging for transcatheter mitral and tricuspid interventions

Abstract

Image guidance for transcatheter mitral and tricuspid valve intervention commonly utilizes the unique advantages of both fluoroscopy and live echocardiography. In some cases, pre-procedural computed tomography is also needed. Classically, they are displayed separately even if modalities are in simultaneous use. This requires procedural operators to watch separate images displaying complementary information and mentally combine these data sources. New hybrid, or fusion, imaging systems allow for multiple imaging modalities to be overlaid on one another to provide the most relevant information on a single screen. While this technological advancement may have some advantages in certain procedures, more data is needed to understand if these systems will improve procedural or clinical outcomes.

3D echocardiography in mitral valve prolapse

“…Based on artificial intelligence algorithms, the model highlights anatomical landmarks, and by using 3D color Doppler TEE imaging, the information about MV flow and regurgitant jets is added to the fused 3D model. Fusion of TEE with fluoroscopy provides procedural operators with real-time guidance, ensuring a precise and safe manipulation of catheters and implantable devices into heart chambers during TEER, transcatheter annuloplasty and transapical chordal replacement ( 125 – 127 ). Other novel techniques applying advanced cardiac multimodality imaging are fusion of pre-procedural computed tomography (CT) with peri-procedural live fluoroscopy and 3D TEE, respectively.…”

Paravalvular Leaks: From Diagnosis to Management

“…Precise sizing using 3D multiplanar reconstruction is a key to choose an adequate device when a TPVL is indicated. Identification of calcifications and IE signs are important to discuss the feasibility and difficulty of a TPVL or surgical treatment (Table 2) [16,17].…”

The evolving role of multi-modality imaging in transcatheter tricuspid valve interventions

“…Key advantages included the ability to crop (to remove soft tissue details not relevant for the procedure), adjustment overlay translucency (to prevent fluoroscopy from being obscured) and the placing of persistent anatomic reference markers in fluoroscopic space. For tricuspid interventions such as Cardioband implantation, the fusion between the 3D TEE and fluoroscopy may give a better spatial orientation when deploying the anchors ( Figure 10 , courtesy of Pascual et al ( 70 )).…”