|Year : 2022 | Volume
| Issue : 3 | Page : 165-166
Interventional Echocardiography: The Birth of a New Specialty
Munesh Tomar1, Manish Bansal2
1 Department of Pediatrics, LLRM Medical College, Meerut, Uttar Pradesh, India
2 Department of Cardiology, Medanta- The Medicity, Gurugram, Haryana, India
|Date of Submission||08-Nov-2022|
|Date of Acceptance||08-Nov-2022|
|Date of Web Publication||16-Nov-2022|
Senior Director Clinical and Preventive Cardiology, Medanta Heart Institute, Medanta- The Medicity, Gurugram, Haryana - 122 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tomar M, Bansal M. Interventional Echocardiography: The Birth of a New Specialty. J Indian Acad Echocardiogr Cardiovasc Imaging 2022;6:165-6
|How to cite this URL:|
Tomar M, Bansal M. Interventional Echocardiography: The Birth of a New Specialty. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2022 [cited 2023 Feb 4];6:165-6. Available from: https://jiaecho.org/text.asp?2022/6/3/165/361373
Percutaneous structural heart disease (SHD) interventions have been in practice for many years. Several congenital heart diseases (CHDs) such as atrial septal defect, patent ductus arteriosus, ventricular septal defect, coarctation of aorta, and congenital aortic or pulmonary stenosis are being routinely treated successfully via percutaneous approach. At the same time, atrial septostomy and ductal stenting are two well-established palliative procedures performed for certain critical congenital heart defects in which immediate survival is dependent on these fetal communications, until the patients can undergo a more definitive treatment. Examples are complete transposition of great vessels and duct dependent systemic or pulmonary blood flow.
Among acquired heart diseases, balloon mitral valvotomy for mitral stenosis is the most performed procedure, having already benefited hundreds of thousands of patients. Device closure of periprosthetic leak in patients who have previously undergone a valve replacement surgery is another common example. Undoubtedly, the journey of SHD interventions has been a story of innovative thinking, bioengineering marvel, and the unending desire to improve patient outcomes.
However, despite this long history of success, the field of SHD interventions has really exploded over the last decade with the advent of several new procedures aimed at treating a variety of valve lesions. It is remarkable to see that within a short span, transcatheter aortic valve replacement (TAVR) has leapfrogged surgical aortic valve replacement (SAVR) to become the treatment of choice for patients with symptomatic severe aortic stenosis who require a bioprosthetic heart valve (BPHV). TAVR has been shown to be superior to SAVR in patients at high surgical risk and is at least non-inferior to SAVR among those at intermediate or low-risk. Just as native valve TAVR, percutaneous valve-in-valve implantation has also become the procedure of choice for patients with failed surgically implanted BPHVs and interestingly, this procedure is not limited to aortic prosthetic valves alone. Transcatheter edge-to-edge repair (TEER) using MitraClip is another interventional procedure that has become an established treatment option for patients with degenerative or secondary mitral regurgitation who are at high-surgical risk. A similar procedure is being evaluated for tricuspid regurgitation as well. Several other valve designs and procedures are currently under development for treating a wide variety of valve lesions and will certainly transform this field further in the near future.
Multimodality imaging is pivotal to the success of these procedures and the recent advances in the field of cardiac imaging have played a critical role in the revolutionary growth of percutaneous SHD interventions. Echocardiography, computed tomography (CT) and cardiac magnetic resonance imaging are the main modalities used for pre-procedural assessment while echocardiography and fluoroscopy are the mainstay for intraprocedural guidance. Echocardiography is also the primary modality used for post-procedure evaluation and follow-up.
Of all the cardiac imaging modalities, echocardiography is undoubtedly the most useful and the most informative and is integral to any diagnostic strategy. However, CT, with its excellent spatial resolution and the ability to provide comprehensive, three-dimensional, anatomic assessment of structures beyond just the heart, has assumed an increasingly important role in pre-procedural planning. Most of the new generation SHD interventions heavily rely on a comprehensive CT assessment for their success.
In contrast, echocardiography, esp. transesophageal echocardiography (TEE), along with fluoroscopy are the preferred imaging modalities for intra-procedure guidance. TEE, with its ability to permit real-time assessment of cardiac structure and function, inside the cardiac catheterization laboratory, and with high degree of safety is an ideal tool for providing procedural guidance. The advent of three-dimensional TEE with excellent temporal and spatial resolution has been one of the most important advances in this context. Some procedures such as TEER are performed almost entirely under TEE guidance with fluoroscopy only playing a supporting role.
The successful performance of various SHD interventions not only requires advanced imaging modalities but also the personnel who have a high level of expertise in intraprocedural imaging. Not just the echocardiographers, even the interventionists also need to be well-versed with all forms of cardiac imaging modalities relevant to these procedures. Although CHD interventions are invariably performed by those who are already experts in echocardiography, intraprocedural imaging is a skill that requires specific training.
Recognizing the rapid evolution of the field of SHD interventions and the integral role imaging plays in these procedures, the Journal of Indian Academy of Echocardiography and Cardiovascular Imaging has brought out this special issue. Although the excitement surrounding the newer SHD interventional procedures has led to publication of several articles focusing on imaging aspects of these procedures, it is important to remind us that the field of CHD interventions has also been evolving at the same time. Hence, unlike many of the recent publications, this issue of the Journal covers not only the recently developed percutaneous valve interventions but also several other important CHD interventions. The emphasis is on what is relevant to the clinical practice in India and therefore, the procedures being commonly performed in India are included. Since echocardiography is the most important modality for intra- procedure guidance, most of the articles in this issue are devoted to echocardiography. However, given the indispensable role of CT in pre-procedural planning for TAVR and transcatheter mitral valve-in-valve implantation, a separate article has been commissioned to specifically deal with this aspect.
We hope our readers will find these articles very informative and useful to their clinical practice. We invite you all to explore this issue and would be happy to receive your feedback. You may reach out to us at [email protected]
Munesh Tomar, Guest Editor
Manish Bansal, Editor-in-chief