Imaging Modality-Independent Anatomy of the Left Heart

  • Pascal Thériault-Lauzier
  • Nicolò PiazzaEmail author


Since its beginnings, fluoroscopy has been and remains the main imaging modality used during percutaneous coronary interventions. However, with the development of structural heart interventions, several additional imaging modalities are required to achieve optimal clinical results. Indeed, echocardiography and computed tomography (CT) are used today for pre-procedural planning, intra-procedural guidance, and post-procedural follow-up of transcatheter structural interventions [1, 2]. In the case of transcatheter valve replacement, interventional cardiologists rely on echocardiography and computed tomography for patient selection, device sizing, and delivery [3, 4]. Herein, we describe an imaging modality-independent terminology to describe the orientation of tomographic data for the specific purpose of left-sided transcatheter cardiac procedures [5–7]. This terminology is intended to be applied to fluoroscopy, CT, echocardiography, and magnetic resonance imaging, thus facilitating the translation between modalities.


  1. 1.
    Kurra V, Kapadia SR, Tuzcu EM, et al. Pre-procedural imaging of aortic root orientation and dimensions: comparison between X-ray angiographic planar imaging and 3-dimensional multidetector row computed tomography. JACC Cardiovasc Interv. 2010;3:105–13.CrossRefPubMedGoogle Scholar
  2. 2.
    Leipsic J, Gurvitch R, Labounty TM, et al. Multidetector computed tomography in transcatheter aortic valve implantation. JACC Cardiovasc Imaging. 2011;4:416–29.CrossRefPubMedGoogle Scholar
  3. 3.
    Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr. 2012;6:366–80.CrossRefPubMedGoogle Scholar
  4. 4.
    Holmes DR Jr, Mack MJ, Kaul S, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol. 2012;59:1200–54.CrossRefPubMedGoogle Scholar
  5. 5.
    Theriault-Lauzier P, Andalib A, Martucci G, et al. Fluoroscopic anatomy of left-sided heart structures for transcatheter interventions: insight from multislice computed tomography. JACC Cardiovasc Interv. 2014;7:947–57.CrossRefPubMedGoogle Scholar
  6. 6.
    Spaziano M, Theriault-Lauzier P, Meti N, et al. Optimal fluoroscopic viewing angles of left-sided heart structures in patients with aortic stenosis and mitral regurgitation based on multislice computed tomography. J Cardiovasc Comput Tomogr. 2016;10:162–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Piazza N, Mylotte D, Theriault LP. Fluoroscopic “heart chamber” anatomy—the case for imaging modality-independent terminology. EuroIntervention. 2016;12:Y9–Y15.CrossRefPubMedGoogle Scholar
  8. 8.
    Bushberg JT. The essential physics of medical imaging. 3rd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.Google Scholar
  9. 9.
    Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26:921–64.CrossRefPubMedGoogle Scholar
  11. 11.
    Wharton G, Steeds R, Allen J, et al. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Res Pract. 2015;2:G9–G24.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Picard MH, Adams D, Bierig SM, et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr. 2011;24:1–10.CrossRefPubMedGoogle Scholar
  13. 13.
    Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv. 2008;1:74–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Arnold M, Achenbach S, Pfeiffer I, et al. A method to determine suitable fluoroscopic projections for transcatheter aortic valve implantation by computed tomography. J Cardiovasc Comput Tomogr. 2012;6:422–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Binder RK, Leipsic J, Wood D, et al. Prediction of optimal deployment projection for transcatheter aortic valve replacement: angiographic 3-dimensional reconstruction of the aortic root versus multidetector computed tomography. Circ Cardiovasc Interv. 2012;5:247–52.CrossRefPubMedGoogle Scholar
  17. 17.
    Cockburn J, Trivedi U, de Belder A, Hildick-Smith D. Optimal projection for transcatheter aortic valve implantation determined from the reference projection angles. Catheter Cardiovasc Interv. 2012;80:973–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Dvir D, Kornowski R. Percutaneous aortic valve implantation using novel imaging guidance. Catheter Cardiovasc Interv. 2010;76:450–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Piazza N. Obtaining the correct depth of implant using the FluoroCT Double S curve. London: PCR London Valves; 2015.Google Scholar
  20. 20.
    Piazza N. Facilitating TAVR with supra-annular sizing and double S-curve. Chicago: TVT; 2016.Google Scholar
  21. 21.
    Poon KK, Crowhurst J, James C, et al. Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements—utility of three-dimensional rotational angiography. EuroIntervention. 2012;8:538–45.CrossRefPubMedGoogle Scholar
  22. 22.
    Samim M, Stella PR, Agostoni P, et al. Automated 3D analysis of pre-procedural MDCT to predict annulus plane angulation and C-arm positioning: benefit on procedural outcome in patients referred for TAVR. JACC Cardiovasc Imaging. 2013;6:238–48.CrossRefPubMedGoogle Scholar
  23. 23.
    Tzikas A, Schultz C, Van Mieghem NM, de Jaegere PP, Serruys PW. Optimal projection estimation for transcatheter aortic valve implantation based on contrast-aortography: validation of a Prototype Software. Catheter Cardiovasc Interv. 2010;76:602–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Interventional Cardiology DepartmentMcGill University Health Center, Glen Hospital/Royal Victoria HospitalMontréalCanada

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