Echocardiographic, Fluoroscopic and CT guidance for transcatheter structural and coronary interventions

Updated on November 17, 2023
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To Michele - “Your image will never be forgotten” Nicolo Piazza


The patient selection and procedural planning for transcatheter structural interventions have been facilitated by the extensive use of multislice computed tomography (MSCT) multiplanar reconstruction. This imaging technique allows the identification of the optimal fluoroscopic viewing angles of left- and right-sided heart structures, in particular the aortic, mitral and tricuspid valve complexes. The use of standardized fluoroscopic viewing angles, during transcatheter interventions, can be extremely helpful in technically challenging scenarios (e.g., bifurcation stenting, aortic, mitral and tricuspid valve interventions). The continuous refinement of transcatheter procedural techniques and the emergence of novel transcatheter devices challenge our understanding and applicability of multimodality imagining. Mastering multimodality imaging of the heart chamber anatomy can reduce the procedural time, radiation dose, contrast volume, and complications during transcatheter coronary and structural interventions while providing guidance for the operators. In this chapter we aim to describe the anatomy of the heart with respect to structural interventions and coronary arteries by integrating MSCT, fluoroscopy and echocardiography. By doing so, we also describe the utility of optimal fluoroscopic viewing angles in guiding structural and coronary interventions.


Traditionally, percutaneous coronary interventions (PCI) are performed using well-recognized anatomical patterns...

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