Martijn G. H. Vrijkorte

Martin J. Swaans

Omar K. Khalique

Stamatios Lerakis

Frontiers in Cardiovascular Medicine

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TYPE EditorialPUBLISHED 14 February 2024| DOI 10.3389/fcvm.2024.1364243EDITED AND REVIEWED BYPeter Martin Wenaweser,Heart Clinic Zurich, Switzerland*CORRESPONDENCEMartijn G. H. Vrijkortem.vrijkorte@antoniusziekenhuis.nlRECEIVED 01 January 2024ACCEPTED 29 January 2024PUBLISHED 14 February 2024CITATIONVrijkorte MGH, Khalique OK, Lerakis S andSwaans MJ (2024) Editorial: Imaging instructural heart interventions.Front. Cardiovasc. Med. 11:1364243.doi: 10.3389/fcvm.2024.1364243COPYRIGHT© 2024 Vrijkorte, Khalique, Lerakis andSwaans. This is an open-access articledistributed under the terms of the CreativeCommons Attribution License (CC BY). Theuse, distribution or reproduction in otherforums is permitted, provided the originalauthor(s) and the copyright owner(s) arecredited and that the original publication inthis journal is cited, in accordance withaccepted academic practice. No use,distribution or reproduction is permittedwhich does not comply with these terms.Frontiers in Cardiovascular MedicineEditorial: Imaging in structuralheart interventionsMartijn G. H. Vrijkorte1*, Omar K. Khalique2, Stamatios Lerakis3and Martin J. Swaans11Cardiovascular Imaging Department, St. Antonius Hospital, Nieuwegein, Netherlands, 2Division ofCardiology, Department of Medicine, Structural Heart and Valve Center, Columbia University MedicalCenter, New York, NY, United States, 3Mount Sinai Fuster Heart Hospital, New York, NY, United StatesKEYWORDSstructural heart interventions, TAVI, multimodality imaging, echo, fusion, ICE, tricuspidinterventions, MRIEditorial on the Research TopicImaging in structural heart interventionsThe field of transcatheter interventions for structural heart disease is rapidly advancing. Inresponse to an aging population there is an increasing demand for percutaneous solutions.Especially in valvular heart disease, which is increasingly common among olderindividuals facing a prohibitive surgical risk, transcatheter approaches are becoming thepreferred choice.Over the past two decades, there have been significant advancements in transcatheterprocedures, particularly in the aortic and mitral domains. The ongoing refinement indevices and techniques has significantly improved the outcomes in this patientpopulation. This progress has now also expanded into the tricuspid domain.Amidst this evolution in structural heart interventions, the pursuit of safety andefficacy has driven the exploration of cutting-edge imaging techniques, for example 3Dechocardiography, 3D IntraCardiac Echocardiography (ICE) and fusion imaging.Nonetheless, the significance of multimodality imaging remains crucial in the context ofstructural heart disease.This series of articles delves into the crucial aspects of multimodality imaging duringtranscatheter structural heart interventions, such as pre-procedural planning andprocedural guidance.The article by Ho et al. focusses on the adjunctive role of 3-dimensional (3D) ICE instructural heart interventions. The role of 3D ICE in various percutaneous interventionswas explored, including transcatheter mitral and tricuspid interventions, atrial septaldefect closure, and paravalvular leakage closure. The workflow considerations,challenges, and limitations associated with the adoption of 3D ICE are acknowledged.The comparison between 3D ICE and 3D TransEsophageal Echo (TEE) is alsoexplored, concerning the differences in matrix array size, spatial and temporalresolution, and optimal imaging planes. 3D ICE is especially useful in situations wheretechnical challenges arise with TEE.The case report by Medda et al. presents a “snaring-assisted” TAVR procedure forsevere Aortic Stenosis (AS). Pre-operative CT showed severe calcific AS with aporcelain aorta and a gothic aortic arch. The authors successfully performed the TAVRprocedure under complete cerebral protection (CP). Advancement and delivery of thevalve was performed “snaring-assisted” with the “Chaperone” and “Top Hat” technique01 frontiersin.orgVrijkorte et al. 10.3389/fcvm.2024.1364243to avoid interference with the CP device and calcified aortic arch.The technique facilitated an atraumatic advancement of thecatheter resulting in a successful implantation withoutcomplications. Macroscopic assessment of the CP device showedsmall debris of calcium.The pilot study by Bertsche et al. evaluated non-contrast-enhanced 3D Cardiac Magnetic Resonance imaging (CMR) forpreprocedural planning of percutaneous Left Atrial Appendageclosure (LAAc). Currently, TEE and fluoroscopy (XR) are thegolden standard, but with the limitation of exposure to ionizingradiation and contrast. The authors investigated CMR as analternative for quantification of LAA dimensions anddetermining optimal C-arm angulation for LAAc.The study involved 13 patients prior to LAAc. CMR-derived measurements of the landing zone (perimeter andarea) showed excellent congruency with periprocedural XR.However, the maximum diameter from CMR tends tooverestimate compared to XR, likely caused by limited spatialresolution in CMR and non-optimal XR angulation. CMR-based measurements also showed a high correlation withFIGURE 1Proposed workflow algorithm for device class selection for transcatheter trcardiac magnetic resonance imaging; CCT, cardiac computed tomogregurgitation; PAH, pulmonary arterial hypertension; RV, right ventricular; IETEER, transcatheter edge to edge repair; TTVR, transcatheter tricuspid valveFrontiers in Cardiovascular Medicine 02TEE-based measurements. Furthermore, CMR predictedangulation and periprocedural used angulation were in goodaccordance in 85% of cases.The meta-analysis by Lan et al. compared the efficacy andsafety of ICE vs. TEE for guiding transcatheter closure of bothAtrial Septal Defects (ASD) and Patent Foramen Ovale (PFO).The authors incorporated data from 11 studies, involving 4,748patients. ICE was associated with significantly shorterFluoroscopy Time (FT) and Procedure Time (PT) compared toTEE, with similar success rates for complete closure. Patientsguided by ICE also had a shorter hospital stay and ICEdemonstrated a lower incidence of adverse events, includingarrhythmias and vascular complications. This study showed thatICE can reduce radiation exposure, and can eliminate the needfor general anesthesia in ASD and PFO closure, without anincrease in global costs.Koren et al. introduces a predictive model for IliofemoralVascular Complications (IVC) in TransFemoral TranscatheterAortic Valve Replacement (TF-TAVR). IVC remains a significantissue, affecting nearly a quarter of patients. The study aims toicuspid valve intervention. TEE, transesophageal echocardiogram; CMR,raphy; CIED, cardiac implantable electronic devices; TR, tricuspid, infective endocarditis; AF, atrial fibrillation; RCA, right coronary artery;replacement.frontiersin.orgVrijkorte et al. 10.3389/fcvm.2024.1364243create a risk score for calcified and tortuous vessels, usinganatomical parameters from a retrospective analysis of 3,119 TF-TAVR patients. CT images from 516 matched patients were usedto establish a predictive model, validated with a cohort of 609patients. Predictors for IVC include Sheath-to-Femoral Arterydiameter Ratio (SFAR), Sum Of Angles (SOA), Number OfCurves (NOC), and Minimal Lumen Diameter (MLD). Theindexed risk score (CSI), incorporating SOA, NOC, and MLD,exhibits strong sensitivity and specificity. In the final model,including SFAR >1.00 and the CSI set to >100, sensitivity andaccuracy was further improved and resulted in a robust modelfor IVC risk stratification in TF-TAVR.The review by Abdelshafy et al. explored the use of quantitativeaortography by Video-Densitometry (VD) to evaluate theRegurgitant Fraction (RF) after Transcatheter Aortic ValveReplacement (TAVR), focusing on ParaValvular Leak (PVL).Although TransThoracic Echo (TTE) is safe and the preferredoption for assessing PVL, the lack of consistency poses alimitation. Angiography enables immediate post-procedural PVLgrading with the sum of all jets, and significant PVL can becorrected with post-dilatation.The authors suggest an Left Ventricular Outflow Tract-AorticRegurgitation (LVOT-AR) of 17% as the optimal threshold todistinguish in AR severity. This correlated strongly with intra-procedural TEE. This was further confirmed with CMR-derivedRF for PVL quantification. LVOT-AR can also serve as a tool toguide decision making for Balloon Post-Dilatation and can offerinsights into the performance of different devices.The review by Tomlinson et al. provides a comprehensiveoverview of the landscape of Transcatheter Tricuspid ValveInterventions (TTVI), emphasizing the pivotal role ofmultimodality imaging. This article describes protocols andmethodologies employed in the multimodality assessment of TR.It aims to provide insight into the pathophysiology of TR, andFrontiers in Cardiovascular Medicine 03anatomical and functional characteristics, critical for appropriatedevice selection.Moreover, intra-procedural imaging recommendations arepresented, including Transcathter Edge-to-Edge Repair (TEER),annuloplasty, orthotopic valves, and heterotopic valves. Allrelevant imaging modalities are being addressed for eachparticular device, emphasizing the role of 3D rendering andMultiPlanar Reconstruction (MPR).The authors also provided a workflow algorithm for adequatedevice selection (Figure 1).Author contributionsMV: Writing – original draft, Writing – review & editing.OK: Writing – review & editing. SL: Writing – review & editing.MS: Writing – original draft, Writing – review & editing.Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that couldbe construed as a potential conflict of interest.Publisher’s noteAll claims expressed in this article are solely those of theauthors and do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. Any product that may be evaluated in this article, orclaim that may be made by its manufacturer, is not guaranteedor endorsed by the publisher.frontiersin.org

Editorial: Imaging in structural heart interventions

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Editorial: Imaging in structural heart interventions

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