Imaging for transcatheter native tricuspid valve intervention: patient selection, procedural planning and interventional guidance

Hypertrophic cardiomyopathy (HCM) is a highly heterogeneous disease with varied patterns of hypertrophy. Basal septal hypertrophy and systolic anterior motion (SAM) of the mitral valve (MV) are the key pathophysiological components to left ventricular outflow tract (LVOT) obstruction in HCM. LVOT is associated with higher morbidity and mortality in patients with HCM. Percutaneous septal reduction therapy with alcohol septal ablation (ASA) can lead to a significant improvement in left ventricle haemodynamics, patient symptoms and perhaps prognosis. ASA delivers pure alcohol to an area of myocardium via septal coronary arteries; this creates damage to tissue akin to a myocardial infarction. The basal septal myocardium involved in SAM–septal contact is the target for this iatrogenic infarct. Appropriate patient selection and accurate delivery of alcohol are critical to safe and effective ASA. Securing the correct diagnosis and ensuring suitable cardiac anatomy are essential before considering ASA. Pre-procedural planning and intra-procedural imaging guidance are important to delivering precise damage to the desired area. The procedure is performed worldwide and is generally safe; the need for a pacemaker is the most prominent complication. It is successful in the majority of patients but room for improvement exists. New techniques have been proposed to perform percutaneous septal reduction. We present a review of the relevant pathophysiology, current methods and a summary of available evidence for ASA. We also provide a glimpse into emerging techniques to deliver percutaneous septal reduction therapy.

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Left Atrial Appendage Closure for Stroke Prevention

EMJ Interventional Cardiology ◽

10.33590/emjintcardiol/21f20701 ◽

2021 ◽

pp. 22-24

Author(s):

Evan Kimber

Keyword(s):

Patient Selection ◽

Stroke Prevention ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

University Hospital ◽

Left Atrial Appendage Closure ◽

National University ◽

Procedural Planning

IMPLEMENTING an effective patient-selection approach, integrating device choice, procedural planning, and patient follow-up, have proven crucial to the success of left atrial appendage closure (LAAC) therapy for atrial fibrillation (AF). This was the focus of the EuroPCR 2021 ‘Structural Theatre’ session, which compared LAAC and direct oral anticoagulant (DOAC) treatment avenues for stroke prevention. In this session, Patrick Calvert, from Royal Papworth Hospital in Cambridge, UK, gave a presentation on patient selection, alongside Ole De Backer of Copenhagen University Hospital, Denmark, who discussed device selection and planning using CT imagery. Ivan Kuntjoro, from the National University Heart Centre of Singapore, briefly outlined left atria morphology, and Farell Hellig of Sunninghill Hospital, Johannesburg, South Africa, introduced procedural plans in a step-by-step approach while performing a live procedure. The session was concluded by Edgar Tay, UK Royal College of Physicians, who gave his insights on several of these topics and concluded the stream with how to optimise patient follow-up care.

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