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Cardiology
TEE to Guide Interventional Cardiac Procedures in the Catheterization Laboratory
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
8 sections · 121 slides
Overview
- Scope of transesophageal echocardiographic guidance
- Interventional echocardiography as a subspecialty
- Training and reimbursement gaps
- Radiation exposure to the structural imager
- Complication rates of periprocedural TEE
- Contribution of three-dimensional TEE
- Resolution limits and settings in 3D TEE
- Hub of periprocedural imaging modalities
- Intracardiac echocardiography: current role
- Intracardiac versus transoesophageal echocardiography
- Echo-fluoroscopy fusion imaging
- Barriers to routine fusion imaging
- Echo-fluoroscopy fusion guidance of paravalvular leak closure
- Transseptal puncture: purpose and rationale
- Complications of transseptal puncture
- Interatrial septal anatomy and variants
- Mid-oesophageal views for crossing the septum
- Tenting and confirmation of septal crossing
- Transseptal puncture under transoesophageal guidance
- Procedure-specific transseptal target sites
Patent foramen ovale and atrial septal defect closure
- Indications for patent foramen ovale closure
- Percutaneous versus surgical atrial septal defect closure
- Choice of imaging modality for septal closure
- Preprocedural confirmation of interatrial shunting
- Right atrial variants and exclusions before closure
- Transoesophageal views for septal defect assessment
- Intraprocedural guidance of device delivery
- Balloon sizing and confirmation of device position
- Atrial septal defect and patent foramen ovale closure
- Postprocedural evaluation after septal closure
Left atrial appendage occlusion
- Indications and approved occlusion devices
- Preprocedural assessment of appendage morphology
- Imaging planes for appendage measurement
- Cardiac computed tomography for appendage planning
- Transseptal trajectory for appendage access
- Biplane guidance of device delivery to the appendage
- Echocardiographic and fluoroscopic view equivalents
- Watchman left atrial appendage occlusion
- Release criteria before device deployment
- Detection of peri-device leak
- Intracardiac echocardiography for appendage occlusion
- Follow-up imaging after appendage occlusion
- Clinical significance of residual peri-device leak
Transcatheter aortic valve replacement
- Indications and team-based patient selection
- Evolution of anaesthetic and imaging strategy
- Echocardiographic criteria for severe aortic stenosis
- Low-flow, low-gradient aortic stenosis
- Cardiac computed tomography for procedural planning
- Three-dimensional TEE for annular sizing
- Annular sizing for transcatheter aortic valve replacement by three-dimensional TEE
- Intraprocedural guidance of valve deployment
- Target implantation depth by valve platform
- Consequences of malpositioned implantation depth
- Post-deployment assessment of valve function
- Paravalvular leak mechanism directs management
- Immediate complications detected by TEE
- Cases where TEE guidance remains preferred
- BASILICA leaflet laceration technique
- Echocardiographic guidance during BASILICA
- Longitudinal surveillance after valve replacement
- Subclinical leaflet thrombosis on computed tomography
- Grading paravalvular leak after aortic valve replacement
Mitral transcatheter edge-to-edge repair
- Principle and approved devices for mitral repair
- Establishing the mechanism of mitral regurgitation
- Echocardiographic criteria for severe mitral regurgitation
- Anatomic features favourable for edge-to-edge repair
- Anatomic features unfavourable for edge-to-edge repair
- Transoesophageal views of the mitral valve
- Transseptal puncture height for mitral repair
- Advancing the clip delivery system
- Clip arm orientation and leaflet grasp
- Live three-dimensional multiplanar reconstruction for grasping
- Mitral transcatheter edge-to-edge repair with MitraClip
- Balancing regurgitation reduction against iatrogenic stenosis
- Deciding whether to release or reposition
- Complications and follow-up after mitral repair
Transcatheter mitral valve replacement
- Indications and available platforms
- Preprocedural echocardiographic assessment
- Grading mitral stenosis in calcific valves
- Anatomic suitability and role of computed tomography
- Risk and mitigation of outflow tract obstruction
- Pre-emptive procedures to enlarge the neo-outflow tract
- Access and preparation for valve delivery
- Guidance of valve positioning and deployment
- Transcatheter mitral valve replacement in mitral annular calcification
- Post-deployment assessment and complications
- Mechanisms of mitral paravalvular leak
- Percutaneous closure of a mitral paravalvular leak
Transcatheter tricuspid valve interventions
- Burden of tricuspid regurgitation and surgical limits
- Approved and investigational tricuspid devices
- Aims of screening before tricuspid intervention
- Transthoracic versus transoesophageal tricuspid imaging
- Five-grade classification of tricuspid regurgitation
- Quantification and mechanism of tricuspid regurgitation
- Leaflet anatomy and feasibility of tricuspid repair
- Transoesophageal windows for the tricuspid valve
- Guidance strategy for tricuspid valve replacement
- Views for tricuspid edge-to-edge repair
- Tricuspid transcatheter edge-to-edge repair with TriClip
- Post-procedural assessment after tricuspid intervention
- Transcatheter tricuspid valve replacement with the Evoque device
- Longitudinal follow-up after tricuspid intervention
Summary
- Phases of echocardiographic contribution
- Key points
- References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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