Abstract
Interventional imaging is maturing into a complex field, which addresses an extremely diverse pathology and integrates the findings of multimodality imaging. The interventional imager is an essential member of a multidisciplinary team focused on the transcatheter treatment of structural heart disease. Advanced echocardiography and cardiac computed tomography techniques and interpretation skills are required in order to provide instrumental information in all stages of patient care, from diagnosis through intraprocedural guidance and follow-up.
Highlights
The recent exponential growth and interest in transcatheter therapies of structural heart disease fostered the development of a new subspecialty: interventional imaging
transcatheter aortic valve replacement (TAVR) is established as an effective treatment of aortic stenosis (AS), and a viable alternative to surgical valve replacement
Large sensor (16 cm z axis) CT scanners are capable of performing the whole TAVR imaging protocol in one pass, with single contrast injection and single breath hold, which results in a 30-40% reduction of the radiation and contrast agent doses
Summary
The recent exponential growth and interest in transcatheter therapies of structural heart disease fostered the development of a new subspecialty: interventional imaging. The interventional imager is responsible for vetting the procedure as meeting essential criteria: (i) clinically indicated, (ii) applicable to a suitable anatomy, and (iii) technically feasible This critical analysis ensures the judicious use of structural heart invasive procedures as well as favorable patient outcomes. A simple and practical framework is to identify the left atrial appendage (LAA) as a lateral structure, aortic valve and left ventricular outflow tract as anterior structures, pulmonary veins and coronary sinus as posterior structures, and the interventricular and interatrial septum as medial structures (Figure 1). Once these reference landmarks are located, any other anatomical structure can be identified. With the exception of transcatheter aortic valve replacement (TAVR) which does not require intraprocedural TEE imaging guidance, virtually all other structural heart disease transcatheter interventions are fundamentally imaging driven procedures
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