Echocardiographic Imaging in Transcatheter Structural Intervention: An AAE Review Paper (JACC Asia August 2023)-Article: Echocardiographic Imaging in Transcatheter Structural Intervention: An AAE Review Paper

Article: Echocardiographic Imaging in Transcatheter Structural Intervention: An AAE Review Paper

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The review, led by Raja Ezman Raja Shariff and other experts, discusses the important role of echocardiographic imaging in guiding transcatheter structural heart interventions (TSHI) in patients unsuitable for surgical options. As TSHIs have become increasingly common globally, including in Asia, the need for specialized echocardiographic guidance from “structural imagers” has grown. The document outlines the various echocardiographic techniques used for TSHIs, such as 3D echocardiography, fusion imaging, and intracardiac echocardiography (ICE), along with their applications.<br /><br />Key highlights include:<br /><br />1. **Imaging Techniques**: The review emphasizes the use of transesophageal echocardiography (TEE) and its advanced 3D techniques, like multiplanar reconstruction and photorealistic imaging, which help in accurately visualizing the heart structures during interventions. Fusion imaging, which integrates TEE with fluoroscopy, is noted for its ability to enhance procedural guidance and safety. ICE also shows promise, although it comes with certain challenges.<br /><br />2. **Interventional Procedures**: Various procedures are discussed, detailing how echocardiographic guidance is crucial:<br />   - **Transseptal Puncture**: Important for procedures like percutaneous transvenous mitral commissurotomy (PTMC) and left atrial appendage occlusion (LAAO).<br />   - **Atrial Septal Defect (ASD) Closure**: TEE and ICE provide detailed imaging of the defect and surrounding structures.<br />   - **Mitral Valve Interventions**: Includes repair techniques like transcatheter edge-to-edge repair (TEER) and valve-in-valve procedures, with TEE guiding the transseptal puncture and device deployment.<br />   - **Tricuspid Valve Interventions**: Involves techniques like TEER and annuloplasty, where echocardiography helps in the precise placement of devices.<br />   - **Aortic Valve Interventions (TAVR)**: TEE helps to confirm device positioning and identify complications such as aortic regurgitation.<br />   - **Paravalvular Leak Closure**: Echocardiography assists in locating and sizing defects for successful device placement.<br /><br />3. **Competency and Training**: The review calls for developing a structured curriculum and training for cardiologists in Asia to specialize in interventional echocardiography, ensuring the quality and success of TSHIs.<br /><br />The article concludes underscoring the critical role of echocardiographic imaging in ensuring procedural success and safety in TSHIs and the need for enhanced training and collaboration among cardiologists in Asia.

Keywords

echocardiographic imaging

transcatheter structural heart interventions

TSHI

3D echocardiography

fusion imaging

intracardiac echocardiography

transesophageal echocardiography

interventional procedures

cardiologist training

Asia