Al Sergani Hani, Moreo Antonella, Bossone Eduardo, Vriz Olga, Alenazy Ali, Alshehri Ahmed, Al Amri Mohammed, Alhamshari Ahmad, Alamro Bandar, Galzerano Domenico
Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh.
Cardio Center "De Gasperis", Niguarda Hospital, Milan.
Monaldi Arch Chest Dis. 2022 Sep 7;93(2). doi: 10.4081/monaldi.2022.2404.
The interaction between the implanter team and the imager team is critical to the success of transcatheter native mitral valve replacement (TMVR), a novel interventional procedure in the therapeutic arsenal for mitral regurgitation. This imaging scenario necessitates the addition of a new dedicated professional figure, dubbed "the interventional imager," with specific expertise in structural heart disease procedures. As its clinical application grows, knowledge of the various imaging modalities used in the TMVR procedure is required for the interventional imager and beneficial for the interventional implanter team. The purpose of this review is to describe the key steps of the procedural imaging pathway in TMVR using the Tendyne mitral valve system, with an emphasis on echocardiography. Pre-procedure cardiac multi-modality imaging screening and planning for TMVR can determine patient eligibility based on anatomic features and measurements, provide measurements for appropriate valve sizing, plan/simulate the access site, catheter/sheath trajectory, and pros- thesis positioning/orientation for correct deployment and predict the risks of potential procedural complications and their likelihood of success. Step-by-step echocardiographic TMVR intraoperative guidance includes: apical access assessment; support for catheter/sheath localization, trajectory and positioning, valve positioning and clocking; post deployment: correct clocking; hemodynamic assessment; detection of perivalvular leakage; obstruction of the left ventricular outlet tract; complications. Knowledge of the multimodality imaging pathway is essential for interventional imagers and critical to the procedure's success.
植入团队与成像团队之间的相互协作对于经导管原生二尖瓣置换术（TMVR）的成功至关重要，TMVR是二尖瓣反流治疗手段中的一种新型介入手术。这种成像情况需要增加一个新的专门专业人员，即“介入成像师”，其在结构性心脏病手术方面具有特定专业知识。随着其临床应用的增加，介入成像师需要了解TMVR手术中使用的各种成像方式，这对介入植入团队也有益处。本综述的目的是描述使用Tendyne二尖瓣系统进行TMVR手术成像路径的关键步骤，重点是超声心动图。TMVR术前心脏多模态成像筛查和规划可以根据解剖特征和测量结果确定患者是否适合，为合适的瓣膜尺寸提供测量，规划/模拟入路部位、导管/鞘管轨迹以及假体的定位/方向以确保正确植入，并预测潜在手术并发症的风险及其成功的可能性。超声心动图引导TMVR术中的分步操作包括：心尖入路评估；支持导管/鞘管定位、轨迹和位置、瓣膜定位和时钟定位；植入后：正确的时钟定位；血流动力学评估；检测瓣周漏；左心室流出道梗阻；并发症。了解多模态成像路径对介入成像师至关重要，对手术成功也至关重要。
