Imaging Perspective: Winning the Game
Cardiology has been described as a video game for doctors. Teenagers navigate the virtual city of a game knowing from visual memory where every demon resides. The contemporary structural cardiologist integrates 3-D imaging to understand, navigate and experience the heart with visual familiarity.
Contemporary cardiac imaging is an essential tool that directly translates to enhanced procedural safety and efficacy with improved quality of life for our patients. Like a shotgun in the hands of an expert hunter, puncturing the interatrial septum with fluoroscopic landmarks usually hits the target. However, visualizing the septum and crossing with the optimal trajectory to the mitral valve or left atrial appendage is precise with contemporary echo. Advancing a Mitraclip to the P2 segment of the mitral valve and knowing when to add M knob versus pulling the system medial becomes obvious as we watch the Mitraclip engage the mitral valve with a coaxial trajectory and perpendicular arms. We see the leaflets cinched within the clip and mitral regurgitation disappear in procedures that are routinely less than an hour. While the annulus was sized in initial transcatheter aortic valve replacement trials with two-dimensional echo, using contemporary 3-D computed tomography (CT) and echo imaging for transcatheter heart valve selection and valve sizing, recent studies have demonstrated mild or less paravalvular regurgitation in over 95 percent of implanted transcatheter aortic valves while minimizing annulus rupture to less than 0.5 percent. Left atrial appendages are closed in over 95 percent of appropriately selected patients, often in less than 30 minutes. Coronary interventions are tailored to coronary perfusion based on CT derived fractional flow reserve, and patients are selected for fully resorbable coronary stents according to lesion characteristics.
With new devices, images and therapeutic interventions, cardiology has never offered more to our patients or our professional development.
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