ECHOCARDIOGRAPHY-GUIDED INTERVENTIONS: SUPPORTING RADIOLOGY AND CATHETERIZATION TEAMS IN REAL-TIME IMAGING

Abstract

The increasing adoption of percutaneous multivalvular and left atrial appendage occlusion technologies, together with the growing complexity of contemporary interventions, demands a robust approach to intraprocedural multimodal imaging. Echocardiography, especially transesophageal echocardiography (TEE), is central to Multimodal Imaging (MMI)-guided care for the treatment of patients with congenital and structural heart disease (SHD). However, current infra-procedural TEE technology lacks the visualization and interactivity capabilities of x-ray catheterization and computed tomography (CT). Existing complementary imaging modalities primarily rely on two-dimensional imaging, neglecting the enhanced spatiotemporal perception afforded by three-dimensional (3D) imaging. Provision of TEE-centric real-time, interactive, and multimodal MMI that augments innate strengths of existing TEE services, especially during catheterization laboratory procedures, is discussed.

Multimodal TS is well-suited for the majority of contemporary transcatheter interventions. Catheterization teams typically rely on CT-derived 3D or 2D fluoroscopy images for spatial orientation and intraoperative guidance. Providing 3D reconstructed radiology must be a priority when starting a new MMI program. Although hybrid MMI appears to be gaining traction, a 3D CT-TEE hybrid uses a fluoroscopically-reconstructed anatomy in conjunction with a co-registered TEE image. Until certification and regulatory hurdles are overcome, fluoroscopic guidance remains the preferred approach. Radiologist-led integration of hybrid planimetry, registration, and fusion for MMI-guided punctures has been developed in parallel to TTBI. Several studies pointed out the need for catheterization leadership to re-examine their standard of care in pursuing intraprocedural CT/TEE integration (Zhang et al., 2023).

There is a need for robust TEE-centric MMI solutions to augment existing TEE and afford real-time access to radiology, including CT-derived 3D, overlaid with anatomic labels and interactive annotations. Constant vigilance and responsiveness to community expectations for MMI TEE-centric solutions are essential. Application of existing technologies can afford simple solutions for addressing needs but require investment in integration expertise and hybrid capabilities for transformational benefits. Still, any provision of an organization will only flourish if supported by efficient training and continuing education.