Multimodality Imaging to Assess Valvular Heart Disease and Assist - - PowerPoint PPT Presentation

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Multimodality Imaging to Assess Valvular Heart Disease and Assist - - PowerPoint PPT Presentation

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Multimodality Imaging to Assess Valvular Heart Disease and Assist Management Alexander (Sandy) Dick, MD ACC Rockies, 2016 Introduction AVR/TAVI 25-30% AS uncertain - Multimodality Guidelines Appropriate sizing affects outcome

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Multimodality Imaging to Assess Valvular Heart Disease and Assist Management

Alexander (Sandy) Dick, MD ACC Rockies, 2016

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Introduction

  • AVR/TAVI

– 25-30% AS uncertain - Multimodality Guidelines – Appropriate sizing affects outcome – Imaging defines and allows novel access

  • TMVI

– Nomenclature, standardized measuring

  • Structural interventionist as imaging specialist

– Parallel vs collaboration, access to images and analysis tools

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Circ Cardiovasc Imaging. 2016;9

Heart Valve Clinic International Database (HAVEC) Group

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Heart Valve Clinic International Database (HAVEC) Group

Circ Cardiovasc Imaging. 2016;9

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MDCT

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J Am Coll Cardiol. 2014:64:1202-1213

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CMR

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LGE in AVR non ischemic

J Am Coll Cardiol. 2014;64:144–154

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LGE in TAVI non ischemic

J Am Coll Cardiol. 2014;64:144–154

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PET

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Impact CT sizing on TAVR outcomes

  • 133 patients underwent TAVR with MDCT

sizing algorithm and 133 without

  • PVL > mild

– 5.3% MDCT and 12.8% control (p=0.32)

  • Composite in-hospital death, aortic annulus

rupture and PVL > moderate

– 3.8% MDCT and 11.3% control (p=0.020)

Leipsic, et al JACC 2013

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Circle

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Fluoro CT

N Piazza

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UK TAVI Registry

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Transcaval Access

Lederman et al, CCI, 2015

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Transcaval access and closure for transcatheter aortic valve implantation

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Transcatheter mitral valve implantation (TMVI)

  • Based on TAVI experience much earlier

integration of pre/periprocedural imaging

  • Nonplanar annulus; the lack of a circular,

fibrous annular structure; the variability of leaflet and sub- valvular apparatus anatomy and its proximity to the left ventricular

  • utflow tract (LVOT)
  • TMVI has different requirements than TAVI

– Standardization of approaches and nomenclature

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TMVI Anchoring Mechanisms

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MA Segmentation

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Papillary Muscle Anatomy

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Prediction Neo-LVOT

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Prediction Angulation

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Summary

  • Structural interventionist as imaging specialist

– Collaboration vs Parallel, access to images and analysis tools

  • TAVI

– Multimodality Guidelines – Appropriate sizing affects outcome – Imaging defines and allows novel access

  • TMVI

– Nomenclature, standardized measuring