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J Am Soc Echocardiogr. 2019 Jul 15. pii: S0894-7317(19)30719-9. doi: 10.1016/j.echo.2019.05.015. [Epub ahead of print]

Advanced Protocol for Three-Dimensional Transesophageal Echocardiography Guidance Implementing Real-Time Multiplanar Reconstruction for Transcatheter Mitral Valve Repair by Direct Annuloplasty.

Author information

1
Center for Cardiology, Cardiology I, Heart Center, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: martin.geyer@unimedizin-mainz.de.
2
Center for Cardiology, Cardiology I, Heart Center, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
3
Department of Radiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
4
Department of Heart Surgery, Heart Center, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
5
Center for Cardiology, Cardiology I, Heart Center, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhein-Main, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.

Abstract

Transcatheter direct annuloplasty has been introduced as a novel interventional treatment option for severe mitral valve regurgitation. Until now, only one direct annuloplasty device (Edwards Cardioband) has been commercially available, being implanted in more than 250 patients worldwide. Yet this procedure poses greater challenges regarding optimal fluoroscopic and echocardiographic guidance compared with edge-to-edge repair: correct localization and orientation of the anchors upon penetration into the fibrous mitral annulus tissue and the basal left ventricular myocardium are preconditions for an optimal result and essential to avoid damage of the neighboring structures (atrioventricular node, circumflex artery, coronary sinus). Real-time single-beat multiplanar reconstruction has become available as an additional imaging tool for three-dimensional transesophageal echocardiography in most recent echo machines. In this review, we introduce a three-dimensional transesophageal echocardiography-based imaging protocol implementing real-time multiplanar reconstruction for transcatheter direct annuloplasty procedures, which optimizes and also simplifies echocardiographic guidance during the implantation. The advanced echocardiographic protocol might also help to expedite implantation times and potentially increase the safety of the procedure. In this "how-to" article, we describe in detail this novel approach for optimized guidance and compare its advantages and challenges to "conventional" echocardiographic imaging for transcatheter mitral valve repair.

KEYWORDS:

3D-TEE; Direct annuloplasty; Mitral valve regurgitation; Multiplanar reconstruction; Transcatheter mitral valve repair

PMID:
31320267
DOI:
10.1016/j.echo.2019.05.015

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