Procedural Guidance Using Advance Imaging Techniques for Percutaneous Edge-to-Edge Mitral Valve Repair
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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 EchoNavigatorTM (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.
KeywordsGuidance Structural heart disease Mitral clip procedure 3 dimensional Trans-esophageal echocardiogram Percutaneous edge-to-edge mitral valve repair Imaging techniques
field of view
left atrial appendage
real-time 3-dimensional transesophageal echocardiography
Compliance with Ethics Guidelines
Conflict of Interest
Robert A. Quaife has received grant support from and has been a consultant for Philips HealthCare.
Ernesto E. Salcedo has received grant support from Philips Medical.
John D. Carroll has been a consultant for, has received grant support and royalties, and has received travel/accommodations expenses covered or reimbursed from Philips HealthCare.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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