Atlas of 3D Transesophageal Echocardiography in Structural Heart Disease Interventions: Cases and Videos

Ming-Chon Hsiung, Wei-Hsian Yin, Fang-Chieh Lee and Wei-Hsuan Chiang

Atlas of 3D Transesophageal Echocardiography in Structural Heart Disease InterventionsCases and Videos

Ming-Chon Hsiung

Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan

Wei-Hsian Yin

Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan

Fang-Chieh Lee

Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan

Wei-Hsuan Chiang

Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan

ISBN 978-981-10-6936-9e-ISBN 978-981-10-6937-6

https://doi.org/10.1007/978-981-10-6937-6

Library of Congress Control Number: 2018931379

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Preface

Interventional cardiology has recently progressed from coronary and noncoronary vascular interventions to interventions for structural heart disease. The procedures have been developed to treat conditions that have been traditionally managed by surgeries and medical therapies. Moreover, the success of interventional therapies depends highly on the skills of transesophageal echocardiographic imaging, especially three dimensional, which allows visualizing the entire scenario in which interventions take place in a single view.

The field is young and worthy of investigations. While the knowledge, principles, and techniques have been well established by numerous previous publications, we share in this book our clinical experiences mainly by introducing classic and unique cases we have dealt with. We have collected a series of over 35 interesting cases. In each of them, background information, clinical presentations, and diagnostic findings are followed by step-by-step approaches of interventional therapies and outcomes after the procedures. The highlight of the book is that we utilize a large number of illustrations, over 700, to demonstrate various cardiovascular pathologies. Most of the figures are three-dimensional transesophageal echocardiograms; they are cooperated with two-dimensional transesophageal echocardiograms, X-rays, fluoroscopies, computed tomograms, etc. Since the echo images we obtained in clinical practice are moving images, we have also included over 450 videos, which serve as a supplement to the static illustrations in the casebook.

The atlas is composed of five chapters. In chapter one, cases received transcatheter aortic valve implantation are described. Valve-in-valve therapy is discussed in chapter two. Chapter three details the MitraClip procedure. Chapter four covers closure of congenital and acquired cardiac defects. Cases suffered from complications after interventional procedures are provided in the last chapter. It is our hope of this volume to offer readers an insider’s view of three-dimensional transesophageal echocardiography in structural heart disease interventions and to refresh your clinical training.

Growing from conception to completion, this casebook mirrored many of the experiences of parenting, especially wise from the rearing of our previous book, Atlas of Perioperative 3D Transesophageal Echocardiography . Thankfully, Cheng Hsin General Hospital, Taipei, Taiwan, provided us full clinical support. We also appreciate the Division of Cardiovascular and Heart Center for facilitating transesophageal echocardiography in structural heart disease interventions. Lastly, the entire Echocardiography Laboratory is thanked for compiling the cases and delivering the new book to the public.

Ming-Chon Hsiung

Wei-Hsian Yin

Fang-Chieh Lee

Wei-Hsuan Chiang

Taipei, TaiwanTaipei, TaiwanTaipei, TaiwanTaipei, Taiwan

Brief Introduction of Three-Dimensional Transesophageal Echocardiography in Structural Heart Disease Interventions

Modern technological developments have contributed to the progress of new devices and procedures, which have significantly improved the opportunity to effectively treat structural heart diseases. Interventional cardiology has been receiving rapid and wide execution as a practical alternative treatment to surgery for several congenital and acquired diseases. The advent of transcatheter valve implantation and repair techniques set up one of the main revolutions of the last decades. Such development is also thoroughly related to a continuous progress in cardiac imaging. Certainly, multimodality cardiac imaging, such as X-ray, echocardiography, and computed tomography, has become indispensible in providing precise patient selection and in monitoring the interventional procedures in order to elevate the success rate and minimize the incidence of complications. Additionally, the role of transesophageal echocardiography, which requires a careful and noninvasive imaging instrument, has evolved to support the procedures from the initial planning and intraoperative monitoring to the assessment of the acute result and follow-up.

Transesophageal echocardiography is generally regarded as a fundamental imaging tool for guidance of percutaneous procedure. Coupled with fluoroscopy, it provides detailed and dependable information to the operators, enabling measurement of the annulus diameter, origin of the regurgitation, defects and their rims, visualization of devices, and evaluation of the results. However, conventional two-dimensional transesophageal echocardiography has some intrinsic limitations. Locating guiding wires and catheters and assessing device position, particularly when multiple devices are used, can often be challenging with two-dimensional imaging. Three-dimensional transesophageal echocardiography enables accurate localization of guiding wires and catheters during the procedure. It also provides a surgical view to clearly demonstrate the mitral anatomy. In cases where multiple devices are used, three-dimensional transesophageal echocardiography provides information on their arrangement and relationship with surrounding structures. An innovative echocardiographic imaging tool, real-time three-dimensional transesophageal echocardiography, which is based on miniaturized matrix array transducers, allows three-dimensional imaging in real time without the requirement of multiple-beat acquisition and is especially useful for guidance of every phase of percutaneous procedures.

Even if transesophageal echocardiography has been confirmed to be an essential tool for planning and execution of cardiac interventions, the helpfulness of three-dimensional echo is becoming more and more evident along with the developing skills of operators.

Contents

1 Transcatheter Aortic Valve Implantation 1

1.​1 Introduction 1

1.​2 Transapical SAPIEN Valve Implantation 2

1.​3 Transapical SAPIEN Valve Implantation for Lower Limbs Arteries Atherosclerotic Calcifications 5

1.​4 SAPIEN Valve Implantation of Bicuspid Aortic Valve 9

1.​5 Paravalvular Leakage After CoreValve Implantation Decreased with Time 13

1.​6 CoreValve Implantation After David Operation 17

1.​7 Valve-In-Valve Implantation of CoreValve for Malposition 21

1.​8 Implantation of SAPIEN Valve in CoreValve After David Operation 26

1.​9 Demonstration of Left Circumflex During SAPIEN Valve Implantation 32

1.​10 Improvement of Left Ventricular Function After SAPIEN Valve Implantation 35

1.​11 Occasional Find of Atheroma During CoreValve Implantation 40

Suggested Readings 45

2 Valve-In-Valve Therapy 47

2.​1 Introduction 47

2.​2 Mitral Valve-In-Ring Implantation of Lotus Valve 48

2.​3 Mitral Valve-In-Valve Implantation of Lotus Valve 51

2.​4 Aortic Valve-In-Valve Implantation of CoreValve 55

2.​5 Aortic and Mitral Valve-In-Valve Implantation of SAPIEN Valves in One Session 58

2.​6 Occluder and Mitral Valve-In-Valve Implantation for Paravalvular Leakage 62

2.​7 Double Occluders and Mitral Valve-In-Valve Implantation for Paravalvular Leakage 67

2.​8 Recapture of Lotus Valve During Mitral Valve-In-Valve Implantation 71

Suggested Readings 76

3 MitraClip 79

3.​1 Introduction 79

3.​2 Transcatheter Aortic Valve Implantation and MitraClip in One Session 79

3.​3 Mitral Stenosis After the MitraClip Procedure 86

3.​4 Mitral Valve Tear After Double MitraClip Procedure 92

Suggested Readings 98

4 Percutaneous Closure of Congenital and Acquired Cardiac Defects 101

4.​1 Introduction 101

4.​2 Occluder Implantation of Secundum Atrial Septal Defect 101

4.​3 Occluder Implantation of Multiple Atrial Septal Defect 105

4.​4 Occluder Implantation of Muscular Ventricular Septal Defect 108

4.​5 Occluder Implantation of Patent Ductus Arteriosus 111

4.​6 Occluder Implantation of Aortic Annular Pseudoaneurysm After Aortic Valve Replacement 116

4.​7 Occluder Implantation of Left Ventricle to Right Atrium Shunt 121

Suggested Readings 126

5 Complications of Interventional Procedures 127

5.​1 Introduction 127

5.​2 Stroke After Transcatheter Aortic Valve Implantation 127

5.​3 Aortic Valve-in-Valve Implantation of Lotus Valve for Paravalvular Leakage 131

5.​4 Implantation of SAPIEN Valve in CoreValve for Paravalvular Leakage 135

5.​5 CoreValve Embolized to Ascending Aorta 142

5.​6 SAPIEN Valve Embolized to Abdominal Aorta 146

5.​7 Coronary Obstruction After Transcatheter Aortic Valve Implantation 151

5.​8 Iatrogenic Coronary Damage After