Percutaneous interventions are gaining rapid acceptance in cardiology and revolutionizing the treatment of structural heart disease (SHD). As new percutaneous procedures of SHD are being developed, their associated complexity and anatomical variability demand a high-resolution special understanding for intraprocedural image guidance. During the last decade, three-dimensional (3D) transesophageal echocardiography (TEE) has become one of the most accessed imaging methods for structural interventions. Although 3D-TEE can assess cardiac structures and functions in real-time, its limitations (e.g., limited field of view, image quality at a large depth, etc.) must be addressed for its universal adaptation, as well as to improve the quality of its imaging and interventions. This review aims to present the role of TEE in the intraprocedural guidance of percutaneous structural interventions. We also focus on the current and future developments required in a multimodal image integration process when using TEE to enhance the management of congenital and SHD treatments.

Advances in TEE-Centric Intraprocedural Multimodal Image Guidance for Congenital and Structural Heart Disease

Biomedical imaging innovation facilitates a better understanding of the heart’s physiology, performance, function, and structure [...]

Biomedical Imaging Technologies for Cardiovascular Disease - Volume II

Computed tomography (CT) scanning has recently assumed a first-pillar role in the preoperative planning of patients undergoing transcatheter structural heart procedures (e.g., transcatheter aortic valve implantation, TAVI; MitraClip; Triclip; left atrial appendage occlusion, LAAO). A careful preprocedural assessment is crucial for achieving the best possible result, and, currently, CT represents the paramount technique to obtain morphological data on cardiac and vessel structures, thus allowing to choose the most appropriate vascular approach, the type and size of devices, and all the required steps to meet procedural expectations. The image reconstruction accuracy also provides information to predict potential complications such as misplacements and leakages. This review aims to describe the role of CT in the decision-making approach of patients undergoing structural heart interventions and expand the clinicians’ understanding of the benefits and drawbacks of this imaging technique.

/pdf/designing-the-optimal-procedure-role-of-ct-scan-in-the-2w9vasck.pdf

Designing the Optimal Procedure: Role of CT Scan in the Planning of Transcatheter Structural Heart Interventions

BACKGROUND
Valvular heart disease (VHD) requires optimized outpatient management that is generally considered to be best delivered by a dedicated, multidisciplinary team (Heart Valve Clinic, HVC). Although HVC is promoted by clinical guidelines and organized in many centers, real world outcome assessments are limited. Thus, we evaluated the performance, clinical and management outcomes during a 6-year experience with an original HVC model.


METHODS
By interrogating the local database, 1047 consecutive patients admitted to the HVC from January 2015 to October 2020 were found. Management and mortality were checked for all patients. After 3 years of HVC activity, in order to improve appropriateness and efficiency, access priority criteria were introduced. Thus, the study population was divided in two Period subgroups (before and after access criteria introduction) that were compared.


RESULTS
A total of 1047 consecutive patients admitted to the HVC constituted the study population; 346 patients (33%) were recommended for invasive treatment. After a mean follow up of 25.7 ± 3.1 months, 37 patients (3.5%) died. When comparing study periods, statistically-significant increase inpatients' complexity and VHD severity was noticed in Period 2, also translating into higher rate of referral to intervention (39.0% vs. 29.4% in Period 1; p = 0.001). Finally, despite higher rate of elderly and frail patients, operative mortality was not jeopardized.


CONCLUSIONS
The present study reports a comprehensive assessment of the characteristics and outcomes achieved through an original HVC model. Standardization of access criteria supports the HVC improvement.

Performance, clinical outcomes and implementation of an original heart valve clinic model.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, and its incidence has grown within several years, quickly becoming the third leading cause of mortality. The disease is characterized by alveolar destruction, air-trapping, and chronic inflammation due to persistent exposure to a large spectrum of harmful particles. The diagnosis of COPD is made by demonstration of persistent and not fully reversible airflow limitation, and different phenotypes may be recognized based on pathophysiological, clinical, and radiological features. However, COPD is a systemic disease with effects involving several organs. For example, mechanical and functional alterations secondary to COPD involve heart function. Indeed, cardiovascular diseases are highly prevalent in patients affected by COPD and represent the primary cause of mortality in such patients. An electrocardiogram is a simple and cheap test that gives much information about the heart status of COPD patients. Consequently, variations from "normality" can be appreciated in these patients, with the most frequent abnormalities being P-wave, QRS axis, and ventricular repolarization abnormalities, in addition to conduction alterations and a vast number of arrhythmias. As a result, ECG should be routinely performed as a valuable tool to recognize alterations due to COPD (i.e., mechanical and functional) and possible associated heart diseases. This review aims to describe the typical ECG features in most COPD patients and to provide a systematic summary that can be used in clinical practice. 

Electrocardiographic alterations in chronic obstructive pulmonary disease

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Designing the Optimal Procedure: Role of CT Scan in the Planning of Transcatheter Structural Heart Interventions

Performance, clinical outcomes and implementation of an original heart valve clinic model.

Electrocardiographic alterations in chronic obstructive pulmonary disease