Abstract
Paravalvular leak (PVL) is a well-recognized complication after heart valve surgery and transcatheter valve replacement [1, 2]. Historically, repeat open-heart surgery has been the mainstay of treatment for paravalvular leaks [1]. However, recent advances in transcatheter therapies have made percutaneous closure of PVLs a less invasive and safe alternative, especially in those at high risk for repeat surgery. Percutaneous repair of PVLs can be associated with considerable complexity and is advised to be performed at experienced centers [3]. These procedures are heavily reliant on various imaging modalities for pre-procedural planning and intraprocedural guidance. Traditionally, these procedures were guided by 2-dimensional (2D) echocardiographic and fluoroscopic guidance to project complex 3D anatomy. Understandably, this posed challenges for acquiring spatial information that is needed to perform these procedures effectively and safely. The advent of echocardiography and computed tomography angiography (CTA) into 3D and 4D visualization and post-processing technology has allowed a more comprehensive understanding of the anatomy and better intraprocedural guidance. However, individual modalities like fluoroscopy and echocardiography provide different information of the anatomy and are presented separately. It can be challenging for operators to piece together these parallel information simultaneously. The integration of CTA with fluoroscopy (CTA-fluoroscopy fusion) and echocardiography with fluoroscopy (echo-fluoroscopy fusion) in the catheterization laboratory allows operators to overcome many of the challenges posed when these imaging modalities are used individually. Merging relevant information from different imaging modalities on to a composite image, commonly referred to as fusion imaging, has been shown to improve efficacy and safety and reduce the requirement of radiation, contrast, and procedural time [4]. More importantly, fusion imaging provides more accurate intraprocedural guidance when approaching PVL closure.
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Pasala, T.K.R., Jelnin, V., Kronzon, I., Ruiz, C.E. (2017). Fusion Imaging for Paravalvular Leak Closure. In: Smolka, G., Wojakowski, W., Tendera, M. (eds) Transcatheter Paravalvular Leak Closure. Springer, Singapore. https://doi.org/10.1007/978-981-10-5400-6_6
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DOI: https://doi.org/10.1007/978-981-10-5400-6_6
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