Real-time 3D echocardiography-guided transcatheter device closure of atrial septal defects

Procedural guidance using advance imaging techniques for percutaneous edge-to-edge mitral valve repair

The complexity of structural heart disease interventions such as edge-to edge mitral valve repair requires integration of multiple highly technical imaging modalities. Real time imaging with 3-dimensional (3D) echocardiography is a relatively new technique that first, allows clear volumetric imaging of target structures such as the mitral valve for both pre-procedural diagnosis and planning in patients with degenerative or functional mitral valve regurgitation. Secondly it provides intra-procedural, real-time panoramic volumetric 3D view of structural heart disease targets that facilitates eye-hand coordination while manipulating devices within the heart. X-ray fluoroscopy and RT 3D TEE images are used in combination to display specific targets and movement of catheter based technologies in 3D space. This integration requires at least two different image display monitors and mentally fusing the individual datasets by the operator. Combined display technology such as this, allow rotation and orientation of both dataset perspectives necessary to define targets and guidance of structural disease device procedures. The inherently easy concept of direct visual feedback and eye-hand coordination allows safe and efficient completion of MitraClip procedures. This technology is now merged into a single structural heart disease guidance mode called EchoNavigator(TM) (Philips Medical Imaging Andover, MA). These advanced imaging techniques have revolutionized the field of structural heart disease interventions and this experience is exemplified by a cooperative imaging approach used for guidance of edge-to-edge mitral valve repair procedures.

[Progress in pediatric cardiology and congenital heart defects]

We present a review of progress reported in the fields of pediatric cardiology and congenital heart disease between July 2004 and July 2005. The review covers diagnosis, medical treatment, interventional cardiology, and surgery. Among advances in diagnosis, we highlight new diagnostic imaging methods such as three-dimensional echocardiography, magnetic resonance imaging, CT angiography, and tissue Doppler imaging. In the area of fetal cardiology, we focus on advances in fetal interventions, such as percutaneous aortic valvuloplasty, percutaneous pulmonary valvuloplasty, and intact or restrictive atrial balloon septostomy. In interventional cardiology, we highlight advances in the application of percutaneous techniques to adult congenital heart disease to help solve problems resulting from previous surgery, and we review new devices for enabling the percutaneous closure of muscular and membranous ventricular septal defects. In cardiac surgery, a number of developments in valved conduits and in aortic translocation in patients with complex transposition of the great arteries are of particular interest.

[Three-dimensional echocardiography in congenital heart disease]

The introduction of real time three-dimensional (3D) echocardiography has led to its use in everyday clinical practice. The 3D matrix probe enables the instantaneous acquisition of transthoracic volumes. Several modes of 3D are available: 3D volume, biplan and 3D color Doppler. Real time 3D echocardiography gave more accurate description of various congenital heart diseases as well as valvulopathy, shunt and aorta pathology. Fetal 3D echocardiography is available. Quantitative measurement of ventricular volumes could be obtain by 3D echocardiography. The facility of utilisation of the matrix probe should lead to routine usage of 3D echocardiography as with 2D and Doppler method. Its values should be decisive in many congenital cardiac lesions requiring surgery or interventional catheterisation.