Zwei- und dreidimensionale Echokardiografie bei der Behandlung struktureller Herzerkrankungen

Abstract

Catheter based treatment of structural heart disease is a rapidly progressing field. Echocardiography for patient selection and the guidance during percutaneous structural heart procedures has evolved from transthoracic 2D echo guidance of e.g. trancatheter mitral balloon valvuloplasties to more complex procedures such as device closure of congenital defects, left atrial appendage occlusion, repair and replacement of valves, or the closure of paravalvular leaks. In this context, echocardiography is continuously evolving and improving. As 2D technologies are limited in the visualization of complex 3D structures by nature, 3D echocardiography (particularly 3D TEE) recently has become an important adjunct in patient selection and intra-procedural guidance for such procedures. A newly developed EchoNavigator system (Philips Healthcare) may facilitate procedural guidance even further by matching echocardiographic and fluoroscopic images.

Kernaussagen

• Bei katheterbasierten Interventionen an strukturellen kardialen Defekten spielt die Echokardiografie – insbesondere die TEE – zur Unterstützung der angiografischen Bildgebung die Hauptrolle.

• Neben der 2 D TEE hat sich die 3 D TEE etabliert, da sie detaillierte Informationen über die 3 D Morphologie von Defekten liefert und den Verfahrensablauf durch eine räumliche Darstellung von Drähten, Kathetern, Okkludern und Zielstrukturen optimiert.

• Eine integrative, multimodale Bildgebung, wie sie der EchoNavigator in Echtzeit bereitstellt, erlaubt die Fusion von Informationen verschiedener Bildgebungsverfahren (Echokardiografie und Angiografie), was die Einschränkungen einzelner Verfahren teils ausgleicht und die Verfahrenssteuerung weiter erleichtert.

• Literatur

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