TY - JOUR
T1 - Computed tomography optimised fluoroscopy guidance for transcatheter mitral therapies
AU - Van Mieghem, Nicolas M.
AU - Rodríguez-Olivares, Ramón
AU - Ren, Ben C.
AU - Van Gils, Lennart
AU - Maugenest, Annemarie
AU - Geleijnse, Marcel L.
AU - Budde, Ricardo P J
AU - Vogelaar, Johan
AU - Verstraeten, Luc
AU - De Jaegere, Peter P.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Aims: Our aim was to illustrate the pragmatic use of pre-procedural multislice computed tomography (MSCT) to facilitate fluoroscopy guidance of transcatheter mitral valve interventions. Methods and results: A dedicated software package (3mensio Structural Heart) is used to analyse MSCT studies and localise anatomical entities by fluoroscopy which would otherwise be invisible (e.g., interatrial septum, paravalvular leaks, mitral leaflets), and to provide optimal C-Arm gantry angles to facilitate crucial steps of catheter-based mitral interventions. For any given anatomical structure that has been identified by MSCT scan, a line of perpendicularity can be drawn representing an infinite combination of RAO-LAO with cranial-caudal angles. Safety and ergonomic considerations drive the selected angulation to be used in the cathlab. The location of the fossa ovalis can be projected onto the fluoroscopy screen to help direct the needle for transseptal puncture. For MitraClip implantations a C-Arm gantry projection that is either coaxial or perpendicular to the mitral coaptation plane helps to orientate the clip before entering the left ventricle to grasp the mitral leaflets. A periprosthetic mitral leak can be localised relative to the prosthesis in the proposed C-Arm angle. Pre-procedural MSCT is thus complementary to transoesophageal echocardiography for transcatheter mitral interventions. Conclusions: Determination of optimal C-Arm angulations helps localise anatomical entities by fluoroscopy and may expedite complex mitral interventions.
AB - Aims: Our aim was to illustrate the pragmatic use of pre-procedural multislice computed tomography (MSCT) to facilitate fluoroscopy guidance of transcatheter mitral valve interventions. Methods and results: A dedicated software package (3mensio Structural Heart) is used to analyse MSCT studies and localise anatomical entities by fluoroscopy which would otherwise be invisible (e.g., interatrial septum, paravalvular leaks, mitral leaflets), and to provide optimal C-Arm gantry angles to facilitate crucial steps of catheter-based mitral interventions. For any given anatomical structure that has been identified by MSCT scan, a line of perpendicularity can be drawn representing an infinite combination of RAO-LAO with cranial-caudal angles. Safety and ergonomic considerations drive the selected angulation to be used in the cathlab. The location of the fossa ovalis can be projected onto the fluoroscopy screen to help direct the needle for transseptal puncture. For MitraClip implantations a C-Arm gantry projection that is either coaxial or perpendicular to the mitral coaptation plane helps to orientate the clip before entering the left ventricle to grasp the mitral leaflets. A periprosthetic mitral leak can be localised relative to the prosthesis in the proposed C-Arm angle. Pre-procedural MSCT is thus complementary to transoesophageal echocardiography for transcatheter mitral interventions. Conclusions: Determination of optimal C-Arm angulations helps localise anatomical entities by fluoroscopy and may expedite complex mitral interventions.
UR - http://www.scopus.com/inward/record.url?scp=84962198386&partnerID=8YFLogxK
U2 - 10.4244/EIJV11I12A273
DO - 10.4244/EIJV11I12A273
M3 - Article
C2 - 26999682
AN - SCOPUS:84962198386
SN - 1774-024X
VL - 11
SP - 1428
EP - 1431
JO - EuroIntervention
JF - EuroIntervention
IS - 12
ER -