Tilak K.R. Pasala, MD, FACC, FSCAI
Interim Director, Structural and Congenital Heart Center
Program Director, Structural Heart Disease Fellowship
Lucy M. Safi, DO, FACC, FASE
Director of Interventional Echocardiography
As a large referral center, many of Hackensack’s challenges lie in the evaluation of pre-procedural imaging—making sure that each patient receives the appropriate exams and that the images are of diagnostic quality so that the patient can be moved quickly and confidently into treatment.
Dr. Safi states, “As an imager, my job is to evaluate all the images and pre-procedural tests that a patient has. Having the right workup and good quality images is necessary, so the patient gets an overall accurate diagnosis.”
Dr. Safi also notes that Hackensack has observed an increase in the number of mitral valve procedures, which bring challenges in assessment and modification due to the complexity of the valve’s saddle-shaped anatomy and its tendency to calcify.
Properly sizing and evaluating the function of the valve is a time-consuming process, but Dr. Safi has found the Philips EPIQ ultrasound system to provide excellent 3D imaging, with built-in automation that provides fast, easily reproducible results that are less dependent on the operator’s level of experience. Tools such as 3D AutoMV quantify the function, key structures, and size of the mitral valve anatomy to help Dr. Safi and her team quickly and accurately assess each patient and identify the right path to treatment.
Other tools such as Cardiac TrueVue provide new ways to further visualize the mitral valve’s function and anatomy.
xPlane Doppler
Enables accurate representation and doppler quantification of the target flow without losing the correct image alignment.
MultiVue real-time alignment
Allows one-click cropping of a Live 3D image during interventional procedures, and one-click alignment of the catheter within cardiac anatomy.
EchoNavigator cardiac fusion imaging
Uses SmartFusion to fuse live TEE and live fluoroscopicimages in real time. TEE transducer position and orientation are automatically tracked in the X-ray image, allowing the echo and X-ray images to move in sync when the C-arm is repositioned.
Cardiac TrueVue Color with Glass
Appreciate the structure of cardiac anatomy and cardiac flow through real-time rendering with a movable light source that can be applied in both echo and color images. Cardiac TrueVue Glass can also enable a cast-like rendering of any 3D structure.
3D Auto LAA for LAA sizings
Acquire the LAA ostium size quickly and easily, using automation that reduces inter- or intra-user variability and increases confidence during procedures.
3D Auto MV for mitral valve quantification
Analyze the complex anatomy of the mitral valve in 3D, as well as its dynamic mechanics. Geometric measurements such as annular dimensions, leaflet, morphology and coaptation descriptions can be used from the initial discovery of MV disease or pathology, to support device planning, and through monitoring of pre- and postoperative cases.
Once a patient is diagnosed and moved into treatment, a new set of challenges arise related to ensuring the room is set up correctly and the clinical team has access to the tools and information they need for a successful procedure.
During the procedure, the interventionalist and imager must work together seamlessly to navigate and deploy the device at the right location. This process relies on the imager using ultrasound to move back and forth between multiple imaging modes—and between 2D and 3D images—to accurately determine device placement.
Both Dr. Pasala and Dr. Safi have seen the value of EPIQ’s multiplanar reconstruction in driving both confidence and efficiency during the procedure.
“If we are able to see the device well on the image, it gives the operators a feeling of confidence and safety,” says Dr. Pasala.
After a device is placed, clinical teams requirehigh-quality imaging and efficient workflows to assess the completeness of treatment and document results. Tools like TrueVue and GlassVue help the echocardiographer visualize any residual leakage and confirm that functional results are as expected.
Dr. Safi states, “TrueVue is very helpful in patients with prosthetic valve replacements. When we use TrueVue, we’re able to move the light source and really take a fulllook at the prosthesis. If the patient has a perivalvular leak, we can really see where that leak is by moving thelight source.“
Cardiac TrueVue Glass is really helpful for multiple things. When we’re doing Mitra Clip procedures or assessing amitral valve, we’re able to change the density of the tissueto see exactly where the regurgitation is coming from. It saves so much time. When doing LAAO devices, we can make tissue translucent to see the ostium of the left atrial appendage very clearly.”
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