Multimodality Imaging in Transcatheter Mitral Interventions

> The secret of change is to focus all of your energy, not on fighting the old, but on building the new. > > –SocratesBoth echocardiography (specifically transesophageal echocardiography [TEE]) and multidetector row computed tomography (MDCT) have played an integral role in preprocedural planning for transcatheter aortic valve replacement, heavily influencing the moniker of “multimodality imaging.” The strengths of each modalities are complementary (Table), although there is overlap between the preprocedural analyses which can be performed.1,2 Having 2 modalities capable of accurately measuring the same anatomic structure3 has clinical utility. For instance, mandated MDCT annular measurements could not be performed accurately by the core laboratory in 6% to 8% of patients in the Placement of Aortic Transcatheter Valves II SAPIEN 3 trial4 and thus required 3-dimensional (3D)-TEE for transcatheter valve sizing.View this table:Table. Advantages and Limitations of Imaging Modalities for Structural Heart Disease InterventionsSee Articles by Suh et al and Mak et al Perhaps, the most important imaging lesson learned from the transcatheter aortic valve replacement (TAVR) experience is not whether one modality is better or worse than another, but the fact that because of the obvious utility of multiple imaging modalities, the imager has become an essential part of the Heart Team and integral to the preprocedural and intraprocedural planning for any successful transcatheter device implantation.5,6 The imager must have a comprehensive understanding of the anatomy of interest, as well as the intended transcatheter device. Without this knowledge, recommendations for sizing and positioning, as well as anticipation of complications, are not possible. At our institution, review of both MDCT and echocardiographic imaging is part of the initial patient assessment. In addition, an imager is always present for all structural heart disease interventions, allowing the interventionalist or surgeon and the imager to gain experience together. …