Optimal imaging for planning and guiding interventions in structural heart disease: a multi-modality imaging approach

Abstract

Recent advances in catheter-based interventions have provided effective alternative treatments to surgery for several structural heart diseases such as atrial or ventricular septal defects. Particularly, the advent of transcatheter valve implantation/repair techniques constitutes one of the main breakthroughs of the last decades offering an effective alternative to patients with symptomatic valvular heart disease and high mortality operative risk. In addition, the role of novel catheter-based interventions has been explored in several clinical conditions that convey an increased risk of cerebrovascular stroke such as patent foramen ovale or atrial fibrillation. Specific devices have been developed to treat all these clinical conditions. To improve the procedural success rate and minimize the frequency of complications, multimodality cardiac imaging plays a central role providing an accurate selection of patients and invaluable assistance during the procedure. Technological advances in the equipments and image post-processing softwares have provided improved accuracy of the image quality and analysis leading to an increasing implementation of these imaging techniques in the clinical practice. The present state-of-the-art article reviews the role of multimodality imaging for planning and guiding interventions in structural heart disease.

Transcatheter Closure of a Large Postinfarction Ventricular Septal Defect Complicated With Perforation of Ventricular Aneurysm

“…Early detection and immediate management are the keys to reduce hazard of death. Realtime TEE proves to be a valuable tool in both procedural guidance and recognition of complication during percutaneous transcatheter closure of postinfarction VSD [12]. It not only confirms the appropriate positioning of occluder but also detects residual shunting after device deployment.…”

Acute pulmonary embolism and patent foramen ovale - neglected risk association

“…Proběhlá ischemická cévní mozková příhoda s předpokladem paradoxní embolie je také důvodem k uzávěru defektu. [38][39][40] Defi nitivní vyřešení otázky indikace katetrizačního uzávěru PFO u jedinců s kryptogenní CMP/TIA přinesou výsledky studií CLOSE a PC-trial. Indikace specifi cké farmakoterapie PFO (anti koagulační nebo antiagregační terapie) jako profylaxe recidivy ischemické cévní mozkové příhody není také jednoznačně stanovena.…”