Author + information
- Received November 19, 2013
- Revision received March 27, 2014
- Accepted April 4, 2014
- Published online June 1, 2014.
- John A. Newland, MB ChB∗,
- Peace Tamuno, MB ChB∗,
- Sanjeevan Pasupati, MB ChB∗,
- Mark Davis, BSc, MB ChB, PhD∗,
- Adam El-Gamel, MB ChB, MD†,
- Gerard Devlin, MB, BCh, BAO, BA, MD∗ and
- Rajesh K. Nair, MBBS∗∗ ()
- ∗Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
- †Department of Cardiothoracics, Waikato Hospital, Hamilton, New Zealand
- ↵∗Reprint requests and correspondence:
Dr. Rajesh Nair, Department of Cardiology, Waikato Hospital, Private Bag 3200, Hamilton, Waikato 3204, New Zealand.
Pre-procedural planning for increasingly complex transcatheter procedures requires accurate and detailed understanding of cardiac anatomy. Echocardiography is widely used but has limitations of interoperator variability (2-dimensional [2D] and 3-dimensional [3D]), wider anatomic appreciation (2D), and suboptimal spatial and temporal resolution (3D). Multidetector computed tomography (MDCT) is an emerging diagnostic tool for structural heart disease intervention planning. Electrocardiogram-gated spiral acquisition protocols using contrast renders anatomic detail at submillimeter level (1). Open-source software allows operators to visualize volume and surface rendered images in 3D. Size, shape, and orientation of target lesions are identified accurately in relation to adjacent anatomy, extra-cardiac structures, orientation of the great vessels, and origin of branch arteries.
MDCT is highly reproducible, with fast acquisition protocols, and complements information provided by echocardiography and fluoroscopy in the planning of complex transcatheter procedures. Limitations of MDCT include exposure to radiation, the windowing effect, and the administration of a contrast medium that may have implications in renal dysfunction. Clinical use of MDCT in treating mitral paravalvular leak (Figs. 1 and 2), aortic paravalvular leak (Fig. 3), ventricular septal defect (Fig. 4), aortic pseudoaneurysm (Fig. 5) and aortic graft endoleak (Fig. 6) are illustrated below.
Transesophageal echocardiography was performed using a Philips IE33 or CX50 ultrasound system (Philips Healthcare, Best, the Netherlands). MDCT was performed using a Siemens SOMATOM Definition Flash scanner (Siemens Healthcare, Erlangen, Germany). Multiplanar and 3D reconstructions were created using Food and Drug Administration–approved DICOM (Digital Imaging and Communications in Medicine) image processing software OsiriX (Osirix MD, Pixemo, Berne, Switzerland).
Dr. Pasupati is a proctor for Medtronic, St. Jude Medical, and Edwards Lifesciences (with no financial interest) and is a consultant for Medtronic. Dr. El-Gamel is a consultant for Medtronic and Edwards Lifesciences. Dr. Nair is a consultant to Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 19, 2013.
- Revision received March 27, 2014.
- Accepted April 4, 2014.
- American College of Cardiology Foundation