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Hinzpeter R, Eberhard M, Pozzoli A, von Spiczak J, Manka R, Tanner FC, Taramasso M, Maisano F, Alkadhi H. Dynamic anatomic relationship of the coronary arteries to the valves. Part 1: mitral annulus and circumflex artery. EUROINTERVENTION 2020; 15:919-922. [PMID: 31746756 DOI: 10.4244/eij-d-19-00669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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52
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Hahn RT, Waxman AB, Denti P, Delhaas T. Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature: A Review. JAMA Cardiol 2020; 4:478-487. [PMID: 30994879 DOI: 10.1001/jamacardio.2019.0535] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Severe functional or secondary tricuspid regurgitation (TR) is associated with poor long-term outcomes in natural history studies as well as specific disease states. An understanding of the physiologic causes of the TR is lacking precluding a systematic approach to treatment. Observations The complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart lends insight into the functional changes seen with secondary TR. The association of these changes with changes in pulmonary vascular hemodynamics can lead to a cascade of events that result in disease progression. Conclusions and Relevance Appreciating the role of pulmonary vascular hemodynamics on right ventricular and tricuspid valve morphology and function improves our understanding of the pathophysiology of secondary TR. The limitations of current therapeutic approaches for secondary TR have stimulated interest in improving outcomes with this morbid disease. Changes in timing or approach to intervention require a more comprehensive understanding of the pathophysiology.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Division of Cardiology/New York Presbyterian Hospital, New York-Presbyterian/Columbia University Medical Center, New York
| | - Aaron B Waxman
- Brigham and Women's Hospital Heart and Vascular and Lung Center, Harvard Medical School, Boston, Massachusetts
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center/Maastricht University, Maastricht, the Netherlands
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53
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Winkel MG, Brugger N, Khalique OK, Gräni C, Huber A, Pilgrim T, Billinger M, Windecker S, Hahn RT, Praz F. Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions. Front Cardiovasc Med 2020; 7:60. [PMID: 32432125 PMCID: PMC7214677 DOI: 10.3389/fcvm.2020.00060] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/25/2020] [Indexed: 12/23/2022] Open
Abstract
With the emergence of transcatheter solutions for the treatment of tricuspid regurgitation (TR) increased attention has been directed to the once neglected tricuspid valve (TV) complex. Recent studies have highlighted new aspects of valve anatomy and TR etiology. The assessment of valve morphology along with quantification of regurgitation severity and RV function pose several challenges to cardiac imagers guiding transcatheter valve procedures. This review article aims to give an overview over the role of modern imaging modalities during assessment and treatment of the TV.
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Affiliation(s)
- Mirjam G. Winkel
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Omar K. Khalique
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, United States
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Adrian Huber
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Michael Billinger
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Rebecca T. Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, United States
| | - Fabien Praz
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
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54
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Arora L, Krishnan S, Subramani S, Sharma A, Hanada S, Villablanca PA, Núñez-Gil IJ, Ramakrishna H. Functional Tricuspid Regurgitation: Analysis of Percutaneous Transcatheter Techniques and Current Outcomes. J Cardiothorac Vasc Anesth 2020; 35:921-931. [PMID: 32247538 DOI: 10.1053/j.jvca.2020.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Lovkesh Arora
- Division of Critical Care, Vascular and Organ Transplant Anesthesiology, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sundar Krishnan
- Division of Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sudhakar Subramani
- Division of Cardiothoracic Anesthesiology, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Archit Sharma
- Division of Cardiothoracic Anesthesiology Solid Organ Transplant and Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Satoshi Hanada
- Division of Cardiothoracic Anesthesiology, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Iván J Núñez-Gil
- Interventional Cardiology, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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55
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Maggiore P, Anastasius M, Huang AL, Blanke P, Leipsic J. Transcatheter Mitral Valve Repair and Replacement: Current Evidence for Intervention and the Role of CT in Preprocedural Planning-A Review for Radiologists and Cardiologists Alike. Radiol Cardiothorac Imaging 2020; 2:e190106. [PMID: 33778537 DOI: 10.1148/ryct.2020190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 01/21/2023]
Abstract
The mitral valve is a complex structure with a three-dimensional saddle shape annulus. Mitral regurgitation occurs from leaflet coaptation failure that is either primary (a problem with the leaflets) or secondary (chamber dilatation in the setting of cardiomyopathy). There has been an increase in focus on transcatheter mitral valve interventions, for both mitral repair and replacement. These technologies have rapidly developed to provide treatment for a substantial number of patients with severe symptomatic mitral regurgitation who are at too high of a risk to undergo open heart surgery. CT assessment of the mitral valve has developed with equal rapidity, with regard to preprocedural planning for transcatheter therapies. This review will provide an overview of mitral valve anatomy, an update on the current transcatheter repair and replacement therapies, as well as a focused overview of the role of multislice CT in mitral assessment prior to intervention. © RSNA, 2020.
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Affiliation(s)
- Paul Maggiore
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Malcolm Anastasius
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Alex L Huang
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
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56
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Multimodality Imaging of the Tricuspid Valve and Right Heart Anatomy. JACC Cardiovasc Imaging 2020; 12:516-531. [PMID: 30846125 DOI: 10.1016/j.jcmg.2019.01.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
Abstract
The characterization of tricuspid valve and right-heart anatomy has been gaining significant interest in the setting of new percutaneous transcatheter interventions for tricuspid regurgitation. Multimodality cardiac imaging provides a wealth of information about the anatomy and function of the tricuspid valve apparatus, right ventricle, and right atrium, which is pivotal for diagnosis and prognosis and for planning of percutaneous interventions. The present review describes the role of echocardiography, cardiac magnetic resonance, and multidetector row cardiac computed tomography for right heart and tricuspid valve assessment.
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57
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Imaging Needs in Novel Transcatheter Tricuspid Valve Interventions. JACC Cardiovasc Imaging 2019; 11:736-754. [PMID: 29747849 DOI: 10.1016/j.jcmg.2017.10.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 02/01/2023]
Abstract
The advent of novel transcatheter therapies for severe tricuspid regurgitation (TR) has attracted much attention. Novel 3-dimensional imaging techniques have permitted analysis of the tricuspid valve (TV) anatomy from unparalleled views and better understanding of the underlying pathophysiology of TR. Grading TR and assessment of right ventricular function remain challenging, and although 2-dimensional echocardiography is the mainstay imaging technique to evaluate patients with severe TR the use of 3-dimensional echocardiography and cardiovascular magnetic resonance is increasing. The number of transcatheter interventions for TR is growing, and procedural success relies significantly on the pre-procedural evaluation of the anatomy of the TV, etiology and severity of TR, right ventricular size and function, and importantly, the anatomic relationships of the TV. The role of multimodality imaging in patient selection and procedural planning for transcatheter TV repair is reviewed.
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58
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Patients' selection for transcatheter tricuspid valve interventions: Who will benefit? Prog Cardiovasc Dis 2019; 62:467-472. [DOI: 10.1016/j.pcad.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/08/2019] [Indexed: 01/09/2023]
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59
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Chang CC, Veen KM, Hahn RT, Bogers AJJC, Latib A, Oei FBS, Abdelghani M, Modolo R, Ho SY, Abdel-Wahab M, Fattouch K, Bosmans J, Caliskan K, Taramasso M, Serruys PW, Bax JJ, van Mieghem NMDA, Takkenberg JJM, Lurz P, Modine T, Soliman O. Uncertainties and challenges in surgical and transcatheter tricuspid valve therapy: a state-of-the-art expert review. Eur Heart J 2019; 41:1932-1940. [DOI: 10.1093/eurheartj/ehz614] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/04/2019] [Accepted: 08/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Tricuspid regurgitation (TR) is a frequent and complex problem, commonly combined with left-sided heart disease, such as mitral regurgitation. Significant TR is associated with increased mortality if left untreated or recurrent after therapy. Tricuspid regurgitation was historically often disregarded and remained undertreated. Surgery is currently the only Class I Guideline recommended therapy for TR, in the form of annuloplasty, leaflet repair, or valve replacement. As growing experience of transcatheter therapy in structural heart disease, many dedicated transcatheter tricuspid repair or replacement devices, which mimic well-established surgical techniques, are currently under development. Nevertheless, many aspects of TR are little understood, including the disease process, surgical or interventional risk stratification, and predictors of successful therapy. The optimal treatment timing and the choice of proper surgical or interventional technique for significant TR remain to be elucidated. In this context, we aim to highlight the current evidence, underline major controversial issues in this field and present a future roadmap for TR therapy.
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Affiliation(s)
- Chun Chin Chang
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Rebecca T Hahn
- Structural Heart & Valve Center, New York Presbyterian Hospital, Columbia University Medical Center,161 Fort Washington Avenue, New York, NY 10032, USA
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 3400 Bainbridge Ave, The Bronx, New York, NY, USA
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas- SP, 13083-970, Brazil
| | - Siew Yen Ho
- Brompton Cardiac Morphology Unit, Royal Brompton Hospital, Imperial College London, London, SW7 2AZ UK
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Viale Regione Siciliana 1571, 90100 Palermo, Italy
- GVM Care and Research, Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033, Cotignola, Italy
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital of Zürich, University of Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Nicolas M D A van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Philip Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Thomas Modine
- Department of Cardiovascular Surgery, Hopital Cardiologique CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Osama Soliman
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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60
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Del Val D, Ferreira-Neto AN, Wintzer-Wehekind J, Dagenais F, Paradis JM, Bernier M, O'Connor K, Beaudoin J, Freitas-Ferraz AB, Rodés-Cabau J. Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review. J Am Heart Assoc 2019; 8:e013332. [PMID: 31441371 PMCID: PMC6755858 DOI: 10.1161/jaha.119.013332] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Transcatheter mitral valve replacement (TMVR) has emerged as an alternative therapeutic option for the treatment of severe mitral regurgitation in patients with prohibitive or high surgical risk. The aim of this systematic review is to evaluate the clinical procedural characteristics and outcomes associated with the early TMVR experience. Methods and Results Published studies and international conference presentations reporting data on TMVR systems were identified. Only records including clinical characteristics, procedural results, and 30‐day and midterm outcomes were analyzed. A total of 16 publications describing 308 patients were analyzed. Most patients (65.9%) were men, with a mean age of 75 years (range: 69–81 years) and Society for Thoracic Surgery Predicted Risk of Mortality score of 7.7% (range: 6.1–8.6%). The etiology of mitral regurgitation was predominantly secondary or mixed (87.1%), and 81.5% of the patients were in New York Heart Association class III or IV. A transapical approach was used in 81.5% of patients, and overall technical success was high (91.7%). Postprocedural mean transmitral gradient was 3.5 mm Hg (range: 3–5.5 mm Hg), and only 4 cases (1.5%) presented residual moderate to severe mitral regurgitation. Procedural and all‐cause 30‐day mortality were 4.6% and 13.6%, respectively. Left ventricular outflow obstruction and conversion to open heart surgery were reported in 0.3% and 4% of patients, respectively. All‐cause and cardiovascular‐related mortality rates were 27.6% and 23.3%, respectively, after a mean follow‐up of 10 (range: 3 to 24) months. Conclusions TMVR was a feasible, less invasive alternative for treating severe mitral regurgitation in patients with high or prohibitive surgical risk. TMVR was associated with a high rate of successful valve implantation and excellent hemodynamic results. However, periprocedural complications and all‐cause mortality were relatively high.
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Affiliation(s)
- David Del Val
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | | | | | - François Dagenais
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | | | - Mathieu Bernier
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | - Kim O'Connor
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | - Jonathan Beaudoin
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
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61
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Pulerwitz TC, Khalique OK, Leb J, Hahn RT, Nazif TM, Leon MB, George I, Vahl TP, D'Souza B, Bapat VN, Dumeer S, Kodali SK, Einstein AJ. Optimizing Cardiac CT Protocols for Comprehensive Acquisition Prior to Percutaneous MV and TV Repair/Replacement. JACC Cardiovasc Imaging 2019; 13:836-850. [PMID: 31422136 DOI: 10.1016/j.jcmg.2019.01.041] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/14/2019] [Accepted: 01/22/2019] [Indexed: 01/13/2023]
Abstract
Clinical trials of transcatheter mitral valve and tricuspid valve repair and replacement devices have begun in earnest, with the ultimate goal of providing definitive, nonsurgical treatment for the millions of patients with severe, symptomatic regurgitation, many of whom are too high risk or inoperable for a surgical approach. Computed tomography (CT) angiography offers the potential for detailed anatomic assessment in this patient population, but its optimal implementation for patients with mitral and tricuspid disease requires patient-centered protocol specification reflecting the goal of the scan, an understanding of complex anatomy and pathophysiology, and particulars of CT scanner capabilities. In this paper, the need for new interventional approaches to mitral and tricuspid valve disease is discussed, followed by a detailed review of how to perform a high-quality CT angiography examination, taking into consideration scanner- and patient-specific variables when preparing a pre-mitral or tricuspid protocol. The many possible clinical challenges affecting the performance of cardiac and vascular CT angiography for pre-procedure mitral and tricuspid repair/replacement are reviewed and specific tips, trouble-shooting approaches, and recommendations are provided for how to conduct the best-quality study, be it at an experienced imaging center with the most advanced scanner or at a novice center using an earlier generation CT platform.
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Affiliation(s)
- Todd C Pulerwitz
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Omar K Khalique
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Rebecca T Hahn
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Isaac George
- Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Torsten P Vahl
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Belinda D'Souza
- Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Vinayak N Bapat
- Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Shifali Dumeer
- Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Susheel K Kodali
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York.
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62
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63
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64
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Imaging Assessment of Tricuspid Regurgitation Severity. JACC Cardiovasc Imaging 2019; 12:469-490. [DOI: 10.1016/j.jcmg.2018.07.033] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/30/2023]
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65
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66
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Abstract
Valvular heart disease is a common clinical problem. Although echocardiography is the standard technique for the noninvasive evaluation of the valves, cardiac CT has evolved to become a useful tool in the evaluation of the cardiac structures as well. Importantly, CT allows for improved quantification of valvular calcification due to its superior spatial resolution. It may improve the detection of small valvular or perivalvular pathology or the characterization of valvular masses and vegetations. This review describes the assessment of normal and diseased heart valves by cardiac CT and discusses its strengths and weaknesses.
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67
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Loghin C, Loghin A. Role of imaging in novel mitral technologies-echocardiography and computed tomography. Ann Cardiothorac Surg 2018; 7:799-811. [PMID: 30598896 DOI: 10.21037/acs.2018.09.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As minimally invasive cardiovascular procedures gain popularity, novel transcatheter mitral valve repair devices continue to emerge. The success of these technologies is critically dependent on high quality imaging performed at all stages: patient selection, intervention planning, intraprocedural guidance, monitoring complications and follow-up. We present an overview of specific imaging requirements and challenges applicable to mitral valve interventional techniques. Modern valve imaging is multimodal and primarily combines echocardiography and computed tomography (CT). Echocardiography remains the gold standard for detailed anatomic imaging, complete hemodynamic characterization and real-time guidance and evaluation of procedural success. CT is indispensable for mitral annulus (MA) imaging and in predicting left ventricular outflow tract (LVOT) obstruction post transcutaneous mitral valve replacement (TMVR). 3D modeling, fusion imaging and automated image analysis may further contribute to the evolutionary transformation of valvular heart imaging.
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Affiliation(s)
- Catalin Loghin
- Cardiology Division, UTHealth McGovern Medical School, Houston, TX, USA
| | - Andrei Loghin
- Cardiology Division, UTHealth McGovern Medical School, Houston, TX, USA
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68
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Demir OM, Regazzoli D, Mangieri A, Ancona MB, Mitomo S, Weisz G, Colombo A, Latib A. Transcatheter Tricuspid Valve Replacement: Principles and Design. Front Cardiovasc Med 2018; 5:129. [PMID: 30283790 PMCID: PMC6156134 DOI: 10.3389/fcvm.2018.00129] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
Tricuspid regurgitation (TR) may affect as much as 65-85% of the population with the prevalence of moderate-to-severe TR in the United States reported at greater than 1.6 million. However, only 8,000 tricuspid valve operations are performed annually in the United States. As severe TR is associated with poor outcomes, there is an unmet clinical need for surgical or percutaneous transcatheter based treatment of TR. Over the last two decades there have been significant developments in percutaneous transcatheter based therapies for valvular disease. However, this progress has not been mirrored for the tricuspid valve until recently; we are now at a cross-roads of new transcatheter devices becoming available for treatment of TR. In this review, we discuss the principles of performing transcatheter tricuspid valve replacement, analyze the devices that can be utilized and outline the challenges related to this procedure.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Damiano Regazzoli
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Satoru Mitomo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giora Weisz
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Antonio Colombo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Weir-McCall JR, Blanke P, Naoum C, Delgado V, Bax JJ, Leipsic J. Mitral Valve Imaging with CT: Relationship with Transcatheter Mitral Valve Interventions. Radiology 2018; 288:638-655. [DOI: 10.1148/radiol.2018172758] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R. Weir-McCall
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Philipp Blanke
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Christopher Naoum
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Victoria Delgado
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jeroen J. Bax
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jonathon Leipsic
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
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70
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Multi-Modality Imaging in the Evaluation and Treatment of Tricuspid Regurgitation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:77. [PMID: 30094651 DOI: 10.1007/s11936-018-0672-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to cover the epidemiology of tricuspid regurgitation (TR), anatomy of the tricuspid valve (TV), and the mechanisms and modern treatment of TR. The focus will be on the role of echocardiography, cardiac CT, and MRI to determine the mechanism, severity, and management strategies of TR. RECENT FINDINGS The evaluation and management of TR is a rapidly growing field with significant advances in both imaging and interventions. Important advances have been made to understand TV anatomy and physiology in 3D echo, CT, and MRI. Additional understanding of the abnormal outcomes in both primary TR and secondary TR have been appreciated. Multiple transcatheter devices have reached the stage of early trials in high surgical risk cohorts with favorable initial findings. TR is a significant cardiovascular problem and vastly undertreated in the present era. There has been tremendous growth in knowledge of mechanisms of TR, its prognostic implications, timing of intervention, and development of novel treatment strategies. Multimodality imaging plays a key role in evaluation and treatment of this condition.
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71
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Asgar AW, Ducharme A, Messas N, Basmadjian A, Bouchard D, Pellerin M. Left Ventricular Outflow Tract Obstruction Following Mitral Valve Replacement: Challenges for Transcatheter Mitral Valve Therapy. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2018. [DOI: 10.1080/24748706.2018.1494397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Anita W. Asgar
- Department of Medicine, Montreal Heart Institute , Montreal, Quebec, Canada
- Faculté de médecine, Université de Montréal , Montréal, Québec, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute , Montreal, Quebec, Canada
- Faculté de médecine, Université de Montréal , Montréal, Québec, Canada
| | - Nathan Messas
- Department of Medicine, Montreal Heart Institute , Montreal, Quebec, Canada
- Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil , Strasbourg, France
| | - Arsene Basmadjian
- Department of Medicine, Montreal Heart Institute , Montreal, Quebec, Canada
- Faculté de médecine, Université de Montréal , Montréal, Québec, Canada
| | - Denis Bouchard
- Department of Medicine, Montreal Heart Institute , Montreal, Quebec, Canada
- Faculté de médecine, Université de Montréal , Montréal, Québec, Canada
| | - Michel Pellerin
- Department of Medicine, Montreal Heart Institute , Montreal, Quebec, Canada
- Faculté de médecine, Université de Montréal , Montréal, Québec, Canada
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72
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Regazzoli D, Mangieri A, Demir O, Ancona MB, Lanzillo G, Giannini F, Leone PP, Colombo A, Latib A. The future of percutaneous tricuspid valve interventions. Minerva Cardioangiol 2018; 66:735-743. [PMID: 29963813 DOI: 10.23736/s0026-4725.18.04757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tricuspid valve regurgitation has a high prevalence and, when severe, is associated with poor outcomes. Nevertheless, surgical repair or replacement (isolated or as a part of a combined procedure) is rarely performed due to high surgical risk. Therefore, there is a significant unmet clinical need for percutaneous transcatheter-based treatments. Significant development in percutaneous therapies for both aortic and mitral valve disease has been accomplished over the last two decades, while transcatheter therapies for the tricuspid valve are still at an early stage. We are today at a cross-road of new transcatheter devices that are becoming available for the treatment of tricuspid regurgitation; the current review evaluates the challenges that current and future technologies have to face in order to become a safer, less invasive and equally effective alternative to surgery.
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Affiliation(s)
- Damiano Regazzoli
- Unit of Cardiovascular Interventions, Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Antonio Mangieri
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Ozan Demir
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Marco B Ancona
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Giuseppe Lanzillo
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Pier P Leone
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, San Raffaele University Hospital, Milan, Italy.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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73
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Trankle CR, Gertz ZM, Koneru JN, Kasirajan V, Nicolato P, Bhardwaj HL, Ellenbogen KA, Kalahasty G. Severe tricuspid regurgitation due to interactions with right ventricular permanent pacemaker or defibrillator leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:845-853. [PMID: 29757467 DOI: 10.1111/pace.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Although thought to be a rare event, permanent pacemakers and implantable cardioverter-defibrillators with right ventricular intracardiac leads have the potential to induce tricuspid valve dysfunction. Adverse lead-valve interactions can take place through a variety of mechanisms including damage at the time of implantation, leaflet pinning, or long-term fibrosis encapsulating the leaflet tissue. Clinical manifestations can display a wide range of severity, as well as a highly variable time span between implantation and hemodynamic deterioration. This review aims to describe the potential pathophysiologic effects of intracardiac device leads on the tricuspid valve, with a focus on ideal diagnostic strategies and treatment options once lead-induced valvular dysfunction is suspected.
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Affiliation(s)
- Cory R Trankle
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary M Gertz
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jayanthi N Koneru
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Nicolato
- Division of Cardiothoracic Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Hem L Bhardwaj
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Gautham Kalahasty
- Divison of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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74
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Asmarats L, Puri R, Latib A, Navia JL, Rodés-Cabau J. Transcatheter Tricuspid Valve Interventions. J Am Coll Cardiol 2018; 71:2935-2956. [DOI: 10.1016/j.jacc.2018.04.031] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/29/2018] [Accepted: 04/15/2018] [Indexed: 01/11/2023]
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75
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Johnston CM, Krafft AJ, Russe MF, Rog-Zielinska EA. A new look at the heart-novel imaging techniques. Herzschrittmacherther Elektrophysiol 2017; 29:14-23. [PMID: 29242981 DOI: 10.1007/s00399-017-0546-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/24/2017] [Indexed: 01/20/2023]
Abstract
The development and successful implementation of cutting-edge imaging technologies to visualise cardiac anatomy and function is a key component of effective diagnostic efforts in cardiology. Here, we describe a number of recent exciting advances in the field of cardiology spanning from macro- to micro- to nano-scales of observation, including magnetic resonance imaging, computed tomography, optical mapping, photoacoustic imaging, and electron tomography. The methodologies discussed are currently making the transition from scientific research to routine clinical use, albeit at different paces. We discuss the most likely trajectory of this transition into clinical research and standard diagnostics, and highlight the key challenges and opportunities associated with each of the methodologies.
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Affiliation(s)
- C M Johnston
- Institute for Experimental Cardiovascular Medicine, University Heart Center, Medical Center - University of Freiburg, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A J Krafft
- Department of Radiology, Medical Physics, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M F Russe
- Department of Radiology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - E A Rog-Zielinska
- Institute for Experimental Cardiovascular Medicine, University Heart Center, Medical Center - University of Freiburg, and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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76
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Yu WL, Omid-Fard N, Arepalli C, Shao M, Hart SL, Weir McCall J, Rosenblatt SR, Blanke P, Leipsic J. Role of Computed Tomography in Pre-Procedural Planning of Transcatheter Mitral Valve Replacement. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1407503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Wong-Li Yu
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong
| | - Nima Omid-Fard
- Department of Radiology and Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, Canada
| | - Chesnal Arepalli
- Department of Radiology and Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, Canada
| | - Michael Shao
- Department of Radiology and Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, Canada
| | - Shmuel L. Hart
- Department of Radiology and Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, Canada
| | - Jonathan Weir McCall
- Department of Radiology and Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, Canada
| | - Samuel R. Rosenblatt
- Department of Radiology and Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, Canada
| | - Philipp Blanke
- Department of Radiology and Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Radiology and Centre for Heart Valve Innovation, St. Paul’s Hospital, Vancouver, Canada
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77
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Shinbane JS, Saxon LA. Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation. J Cardiovasc Comput Tomogr 2017; 12:16-27. [PMID: 29198733 DOI: 10.1016/j.jcct.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 01/17/2023]
Abstract
Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality, cost effectiveness, and overall value to medical care.
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Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Leslie A Saxon
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Buzzatti N, De Bonis M, Moat N. Anatomy of the Tricuspid Valve, Pathophysiology of Functional Tricuspid Regurgitation, and Implications for Percutaneous Therapies. Interv Cardiol Clin 2017; 7:1-11. [PMID: 29157516 DOI: 10.1016/j.iccl.2017.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The tricuspid valve is a complex dynamic apparatus made up of many different closely linked structures: the annulus, the three leaflets, the chordae, the papillary muscles and the right ventricle. Other nearby structures, such as the coronary sinus ostium, the conduction system, the membranous septum, and the right coronary artery must be taken into account when dealing with the tricuspid. Annulus dilation and leaflet tethering due to right ventricular remodeling are the 2 major mechanisms responsible for most tricuspid regurgitation cases. Precise knowledge of tricuspid anatomy and function, as well as careful preoperative planning, is fundamental for successful transcatheter tricuspid procedures.
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Affiliation(s)
- Nicola Buzzatti
- Cardiac Surgery Department, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20129, Italy.
| | - Michele De Bonis
- Cardiac Surgery Department, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20129, Italy
| | - Neil Moat
- Cardiac Surgery Department, Royal Brompton & Harefield Trust, Sydney Street, London SW3 6NP, UK
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80
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Tratamientos percutáneos de la valvulopatía tricuspídea: una nueva esperanza para la válvula «olvidada». Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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81
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Campelo-Parada F, Lairez O, Carrié D. Percutaneous Treatment of the Tricuspid Valve Disease: New Hope for the "Forgotten" Valve. ACTA ACUST UNITED AC 2017. [PMID: 28645836 DOI: 10.1016/j.rec.2017.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tricuspid valve disease is a frequent condition but is currently undertreated. A limited number of patients undergo an isolated surgical tricuspid repair, and this intervention is associated with poor outcomes, especially in patients with previous cardiac surgery. Most patients are only medically treated, despite the impact of severe tricuspid regurgitation on functional status and long-term survival. Transcatheter therapies represent a promising alternative for patients with severe tricuspid regurgitation and high surgical risk. In the last few years, several percutaneous alternatives have been developed for the treatment of functional tricuspid regurgitation. Imaging techniques play an indispensable role in patient selection, procedural guidance and follow-up. The current available transcatheter options for native tricuspid valve disease can be divided into 3 main groups: heterotopic caval valve implantation, annuloplasty devices, and coaptation devices. In patients with previous tricuspid valve surgery, transcatheter valve-in-valve and valve-in-ring procedures have been reported. This review provides a detailed analysis of the novel transcatheter alternatives for the treatment of tricuspid valve disease that have already been successfully implanted in humans, as well as the most important aspects of tricuspid valve anatomy and imaging assessment.
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Affiliation(s)
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, CHU Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, CHU Toulouse, Toulouse, France
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