Guidance of interventions in structural heart disease; three-dimensional techniques are here to stay

A significant part of current daily practice in interventional cardiology consists of interventions in structural heart disease.This involves a diversity of interventions in both acquired and congenital heart defects.A safe and predictable intervention can be a challenge, particularly in patients with congenital heart disease who often have multiple operations in their medical history.Improvements in device technology have shown enhanced procedural and clinical outcome in this often fragile patient group.In addition to technological progress, new imaging tools have emerged for the improvement of patient selection, procedural planning and guidance.Three-dimensional (3D) imaging techniques using echocardiography, computed tomography (CT) or magnetic resonance (MR) for visualisation of the cardiovascular system were introduced in the '80s and '90s [1,2].In the late '90s 3D rotational angiography (3DRA) was developed, but was mainly used in neuroradiology procedures [3].It was only after 2000 that the first manuscripts concerning the use of 3D angiography for coronary anatomy and congenital heart disease appeared [4,5].Remarkably, in the first description of 3DRA, the patient was rotated around the radiation source instead of the other way around [6].An increasing number of centres are currently incorporating 3D techniques using MR/CT, (transesophageal) echocardiography and/or rotational angiography in their daily clinical practice.Moreover,