Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging

Figures

• 

  FIGURE 1. Atrial septal defect (ASD) closure with two devices. Residual ASD (yellow arrow) after device release (A); live 3D echo showing the guidewire passage (yellow arrow) through the residual defect (B); 2D visualization of the devices (C); 3D visualization of devices position and shape (D).

• 

  FIGURE 2. Percutaneous closure of perimembranous ventricular septal defect (pmVSD). Transesophageal echocardiography (TEE), especially 3D, permits visualization of catheter passage through the aortic valve (A) and in the right ventricle (B) (yellow arrow), and live monitoring during (C) and after device release (D) (yellow arrow).

• 

  FIGURE 3. 3D image of pulmonary venous channel in a patient who underwent atrial switch (A). Baffle leak closure (B).

• 

  FIGURE 4. MitraClip implantation for systemic tricuspid valve regurgitation. (A,B) Catheter and needle are positioned at the level of the anterior part of the intra-atrial inferior vena cava channel under transesophageal echocardiography (TEE) guidance. The 80° TEE plane shows needle tenting and guarantees a distance of at least 40 mm between the tenting and the systemic atrio-ventricular valve (SAVV) and the alignment with the SAVV. (C) The balloon is inflated to enlarge the transbaffle access. (D) TEE shows the right to left shunt on color doppler after balloon inflation. (E,F) The guidewire is positioned in the systemic atrium to advance the MitraClip sheath. (G,H) MitraClip sheath is positioned on the systemic atrium at 40 mm or more from the SAVV. (I,J) The MitraClip system is advanced through the sheath and positioned on top of the jet origin, with the clip fully opened. Perpendicular orientation of the clip relative to the anteroseptal commissure is guided by the Xplane 3DTEE in the mid-esophagus position. (K) XTR MitraClip fully closed at the level of the anteroseptal commissure creates a double-orifice SAVV with two mild residual jets on color doppler. (L) Double-orifice SAVV on…

• 

  FIGURE 5. Use of echocardiography-fluroroscopy fusion (EFF) to facilitate mitral paravalvular leak (PVL) closure. (A,B) Anatomical markers placed on fluoroscopy and echocardiography. Marker 1 (yellow arrow) indicate position of transeptal puncture. Marker 2 (white arrow) indicate site of mitral PVL. (B) Color flow Doppler confirming mitral PVL. Combined EFF image allows efficient crossing of PVL (C,D). Continuous feedback from EFF facilitates alignment of delivery sheath and device deployment. (E) Fluoroscopy showed good device position post release, (F) confirmed by echocardiography and no residual leak was observed. Courtesy of Dr. Juan Pablo Sandoval, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico.

• 

  FIGURE 6. Preprocedural simulation of sinus venosus atrial septal defect percutaneous closure. Courtesy of Philips Healthcare.

• 

  FIGURE 7. Digital-reality technologies enable true three-dimensional (3D) modeling and simulation prior to patent ductus arteriosus (PDA) stenting. (A) The 3D model of the PDA in relation to the airway, can be interrogated (B) using a range of interactive features including (C) measurement of distances in 3D space and (C,D) overlaying of stent in the PDA. (E,F) Visualization of the morphology of the 3D model in unlimited planes allows selection of optimal angiographic projection for intervention and planning of the number of stents and length of stent to cover the entire PDA. Post procedure angiography showing position of PDA stent as planned with unobstructed flow into branch pulmonary arteries.