ESC Textbook of Cardiovascular Imaging - sample

Chapter 9
Imaging during cardiac
interventions
Luis M. Rincón and José L. Zamorano
Contents
Introduction 116
Catheterization laboratory procedures 116
Patent foramen ovale (PFO) 116
Atrial septal defects (ASDs) 117
Ventricular septal defects (VSDs) 119
Echocardiography in trans-septal
catheterization 120
Alcohol septal ablation for hypertrophic
obstructive cardiomyopathy 120
Percutaneous closure of left atrial appendage
(LAA) 121
Use of echocardiography to guide myocardial
biopsy 123
Use of echocardiography to guide
pericardiocentesis 123
Use of echocardiography in
electrophysiological procedures 123
Introduction 123
Use of echocardiography for cardiac catheter
ablation of atrial fibrillation 124
Use of echocardiography for other EP ablation
procedures 125
Echocardiography in cardiac resynchronization
therapy procedures 125
References 125
Introduction
Interventional cardiology has evolved during the last decades and the number of
procedures and indications has increased. This offers a new therapeutic option for
conditions that previously required surgery or that were not amenable to any intervention.
In parallel, cardiac imaging has experienced a similar technological development
and it is commonly required in the catheterization laboratory to evaluate, guide and
improve results of several percutaneous procedures [1] ( Table 9.1).
Percutaneous treatment can offer an alternative to surgery in many cases of nonvalvular
structural heart diseases, such as atrial septal defects (ASDs) and patent foramen
ovale (PFO), with cardiac imaging routinely used in this context.
Atrial fibrillation with pulmonary veins ablation and left atrial appendage percutaneous
occlusion are commonly guided by cardiac imaging. Other supraventricular and
ventricular tachyarrhythmias ablation procedures performed in the electrophysiology
laboratory (EP) have become clinical settings in which imaging can be useful.
Echocardiography is routinely used for evaluation, guidance, and follow-up of patients
undergoing alcohol septal ablation for hypertrophic cardiomyopathy (HCM).
Trans-catheter interventions for valvular heart disease, such as aortic stenosis or
mitral regurgitation, are in constant evolution due to their clinical importance and
high prevalence. The use of echocardiography in this context is discussed in a separate
chapter.
Catheterization laboratory procedures
Patent foramen ovale
Diagnosis and indications of PFO closure
The foramen ovale plays a role by letting the blood flow across the atrial septum before
birth. Afterwards, right heart pressures and pulmonary resistances decrease due to
breathing and left atrial pressure rises with the beginning of pulmonary venous return.
Septum primum is then shoved against the septum secundum, and a permanent fusion
can be seen by the age of two in most children. Patent foramen ovale (PFO) can occur as a
result of an absence in the fusion of the septum primum with the septum secundum, and
can be seen in 24–27% of adult population. This persistence can cause a blood flow from
the right to the left atrium whenever the pressure is higher in the first. Approximately 30%
of survivors of stroke are said to be cryptogenic, and PFO by TEE has been reported to be
present in around 50% in comparison with 24% for the general population. This has led
clinicians to think that the underlying cause of the stroke was frequently a PFO. In the last
two years several clinical trials such as RESPECT, PC Trial, and CLOSURE I have tried