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

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 – Imaging defines and allows novel access • TMVI – Nomenclature, standardized measuring • Structural interventionist as imaging specialist – Parallel vs collaboration, access to images and analysis tools

Heart Valve Clinic International Database (HAVEC) Group Circ Cardiovasc Imaging . 2016;9

Heart Valve Clinic International Database (HAVEC) Group Circ Cardiovasc Imaging . 2016;9

MDCT

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

CMR

LGE in AVR non ischemic J Am Coll Cardiol . 2014;64:144 – 154

LGE in TAVI non ischemic J Am Coll Cardiol . 2014;64:144 – 154

PET

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

Circle

Fluoro CT N Piazza

UK TAVI Registry

Transcaval Access Lederman et al, CCI, 2015

Transcaval access and closure for transcatheter aortic valve implantation

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 outflow tract (LVOT) • TMVI has different requirements than TAVI – Standardization of approaches and nomenclature

TMVI Anchoring Mechanisms

MA Segmentation

Papillary Muscle Anatomy

Prediction Neo-LVOT

Prediction Angulation

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