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

Netherlands Heart Journal, Jan 2017

M. Voskuil, H. Sievert, F. Arslan

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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 - 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. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 1. Nixon JV , Saffer SI , Lipscomb K , Blomqvist CG . Three-dimensional echoventriculography . Am Heart J . 1983 ; 106 ( 3 ): 435 - 43 . 2. Hale JD , Valk PE , Watts JC , et al. MR imaging of blood vessels using three-dimensional reconstruction: methodology . Radiology . 1985 ; 157 ( 3 ): 727 - 33 . 3. Anxionnat R , Bracard S , Macho J , et al. 3D angiography. Clinical interest. First app (...truncated)


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M. Voskuil, H. Sievert, F. Arslan. Guidance of interventions in structural heart disease; three-dimensional techniques are here to stay, Netherlands Heart Journal, 2017, pp. 63-64, Volume 25, Issue 2, DOI: 10.1007/s12471-016-0945-0