Echo-fluoro fusion imaging guidance for no contrast transfemoral aortic valve implantation

Echo-fluoro fusion imaging guidance for no contrast transfemoral aortic valve implantation Over the past decade, transcatheter aortic valve implantation (TAVI) emerged as preferred treatment for high-risk patients with severe aortic stenosis (AS), expanding towards lower risk patients. Chronic kidney disease (CKD) is one of the most frequent comorbidity. Preprocedural screening includes application of contrast media [computed tomography (CT)], followed by repeated contrast during procedure (coronary angiography, aortic root angiography, and peripheral angiography), increasing risk of acute kidney injury (AKI). AKI in presence of CKD increases the incidence of kidney disorders after TAVI up to 30%. Efforts to abolish periprocedural contrast appear therefore beneficial, like the use of EchoNavigator (Philips, the Netherlands). An 80-year-old male patient with low-flow, low-gradient severe AS (mean aortic valve area 0.6 cmq, mean gradient 29 mmHg, LVEF 10%) and pre-dialytic CKD (creatinine 5.5 mg/dL) was scheduled for no contrast TAVI, under general anaesthesia and fusion guidance. The aortic valve (AV) plane was identified with EchoNavigator and three fiducial markers were placed in correspondence of the nadir of the cusps (Panels A and B), in X-plane view. By superimposing the echo images, the AV and the root become visible on the fluoroscopic screen and the angulation of C-arm was gradually adjusted to co-align the three markers on correct plane (Panel C). The overlayed 3D echo fusion allowed successful implantation of a Sapien 3 26 mm (Edwards Lifesciences, USA), without contrast and preoperative CT (Supplementary data online, Video S1). At transthoracic echo at discharge, only a trivial paravalvular leak was detected (Panel D). In high-risk patients with CKD, use of EchoNavigator as a measure to minimize the risk of AKI during TAVI appears extremely beneficial. (Panels A and B) The three markers, placed at the level of the nadir cusp, are overlayed on fluoroscopy and aligned to reach the coaxial planar projection. Using the echo 3D modality, it is possible to crop thickness of soft tissues, obtaining clearcut imaging of the aortic root (asterisks) and of the valvular plane itself (arrow). (Panel C) During TAVI implantation, the translucency of overlayed 3D tissues is reduced through a specific tool, making catheters and device well visible. (Panel D) Trivial paravalvular leak at 8 o’clock at discharge transthoracic echo. View largeDownload slide View largeDownload slide Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

Echo-fluoro fusion imaging guidance for no contrast transfemoral aortic valve implantation

Loading next page...
 
/lp/ou_press/echo-fluoro-fusion-imaging-guidance-for-no-contrast-transfemoral-Dln4QHwgLS
Publisher
Oxford University Press
Copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
ISSN
2047-2404
D.O.I.
10.1093/ehjci/jey048
Publisher site
See Article on Publisher Site

Abstract

Over the past decade, transcatheter aortic valve implantation (TAVI) emerged as preferred treatment for high-risk patients with severe aortic stenosis (AS), expanding towards lower risk patients. Chronic kidney disease (CKD) is one of the most frequent comorbidity. Preprocedural screening includes application of contrast media [computed tomography (CT)], followed by repeated contrast during procedure (coronary angiography, aortic root angiography, and peripheral angiography), increasing risk of acute kidney injury (AKI). AKI in presence of CKD increases the incidence of kidney disorders after TAVI up to 30%. Efforts to abolish periprocedural contrast appear therefore beneficial, like the use of EchoNavigator (Philips, the Netherlands). An 80-year-old male patient with low-flow, low-gradient severe AS (mean aortic valve area 0.6 cmq, mean gradient 29 mmHg, LVEF 10%) and pre-dialytic CKD (creatinine 5.5 mg/dL) was scheduled for no contrast TAVI, under general anaesthesia and fusion guidance. The aortic valve (AV) plane was identified with EchoNavigator and three fiducial markers were placed in correspondence of the nadir of the cusps (Panels A and B), in X-plane view. By superimposing the echo images, the AV and the root become visible on the fluoroscopic screen and the angulation of C-arm was gradually adjusted to co-align the three markers on correct plane (Panel C). The overlayed 3D echo fusion allowed successful implantation of a Sapien 3 26 mm (Edwards Lifesciences, USA), without contrast and preoperative CT (Supplementary data online, Video S1). At transthoracic echo at discharge, only a trivial paravalvular leak was detected (Panel D). In high-risk patients with CKD, use of EchoNavigator as a measure to minimize the risk of AKI during TAVI appears extremely beneficial. (Panels A and B) The three markers, placed at the level of the nadir cusp, are overlayed on fluoroscopy and aligned to reach the coaxial planar projection. Using the echo 3D modality, it is possible to crop thickness of soft tissues, obtaining clearcut imaging of the aortic root (asterisks) and of the valvular plane itself (arrow). (Panel C) During TAVI implantation, the translucency of overlayed 3D tissues is reduced through a specific tool, making catheters and device well visible. (Panel D) Trivial paravalvular leak at 8 o’clock at discharge transthoracic echo. View largeDownload slide View largeDownload slide Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

European Heart Journal – Cardiovascular ImagingOxford University Press

Published: Mar 22, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off