Guidance of interventions in structural heart disease; three-dimensional techniques are here to stay
Neth Heart J
Guidance of interventions in structural heart disease; three-dimensional techniques are here to stay
M. Voskuil 0 1 2
H. Sievert 0 1 2
F. Arslan 0 1 2
0 Laboratory of Experimental Cardiology, University Medical Center Utrecht , Utrecht , The Netherlands
1 CardioVascular Center Frankfurt , Frankfurt , Germany
2 Department of Cardiology, University Medical Center Utrecht , Utrecht , The Netherlands
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Published online: 17 January 2017
© The Author(s) 2017. This article is available at SpringerLink with Open Access.
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, 3D printing has emerged as an
additional tool for this patient cohort. Using 3D printing,
patient-specific implants and devices can be designed and
tested, opening new horizons in personalised patient care
and cardiovascular research. Furthermore, physicians can
better elucidate anatomical abnormalities with the use of
3D-printed models and improve communication with their
patients.
In this special issue of the Netherlands Heart Journal
on imaging and interventions in structural heart disease,
it is striking that a substantial number of the submitted
manuscripts concern these 3D imaging and printing
techniques [
7–10
]. This emphasises the keen interest of
researchers and clinicians in the current developments in
imaging for structural heart disease. Goreczny et al.
describe the additional value of 3D in the guidance of
percutaneous pulmonary valve implantation (PPVI) that resulted
in a reduction in exposure to contrast and radiation when
compared with traditional 2D guidance [7]. These findings
are in line with a recent paper from Starmans et al., who
showed the diagnostic quality of 3DRA to be superior in
children with an aortic coarctation, with less radiation
exposure than conventional angiography (CA) [
11
].
Furthermore, in the current issue Pockett et al. state that during
PPVI, 3DRA may facilitate higher procedural success and
decrease the risk of serious adverse events such as coronary
artery compression [
8
]. As in many studies on congenital
heart disease, it is difficult to test the additional value of
3DRA compared with CA in a true randomised or
controlled study. Nevertheless, the studies mentioned earlier
seem to confirm the experience of the users of 3DRA, i. e.
that this technique enhances procedural safety and
technical outcome. In mainstream coronary artery intervention
CA techniques still seem adequate for an efficacious and
safe outcome of the procedure. However, the limitations
of CA include the simultaneous opacification of overlying
without exposing patients to higher doses of radiation. It is
likely that radiation usage in 3DRA will be further reduced,
favouring the use of this technique in daily clinical practice.
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