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4D CT RECONSTRUCTION for PLANNING d IMPLEMENTATION fPLANNING and IMPLEMENTATION of
SHD INTERVENTIONSHD INTERVENTION Howard A Cohen, MD, FACC, FSCAI
Director Division of Cardiovascular InterventionDirector Division of Cardiovascular InterventionCo‐Director Cardiovascular Interventional Laboratories
Lenox Hill Heart & Vascular Institute
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill ExperiencepStructural Heart Disease Team
• Carlos E Ruiz, MD, PhD– Director Structural Heart Disease Program LHH
H d A C h MD• Howard A Cohen MD– Director Cardiac Catheterization Laboratories ‐ LHH
• Vladimir Jelnin MD• Vladimir Jelnin MD– Director 3D/4D Cardiac CT Imaging Laboratory ‐ LHH
• Itzhak Kronzon MDItzhak Kronzon MD– Director, CV Imaging LHH
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA for Planning and Implementation of SHD Intervention
i f i d li iIntegration of Imaging Modalities• 4D CTA• Fluoroscopy• 3D TEE• 3D TEEThree applications• Paravalvular leak closure (Mitral)• Transapical punctureTransapical puncture• TAVI (CoreValve)
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
Paravalvular LeaksAccessAccess
• Location will determine the best accessbest access
• Access– Antegrade (transseptal)
• IVC
• SVC
– Retrograde
– TransapicalLenox Hill Heart and Vascular
Institute of New YorkLenox Hill Heart and Vascular
Institute of New York
Transapical
Paravalvular LeaksMitral Valve
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA and Mitral PVL Closure4D CTA and Mitral PVL Closure
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA and Mitral PVL Closure4D CTA and Mitral PVL Closure
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
3D TEE and Mitral PVL Closure3D TEE and Mitral PVL Closure
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
PERCUTANEOUS PVL CLOSURELHH EXPERIENCE
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
Accepted for publication JACC
PERCUTANEOUS PVL CLOSURELHH EXPERIENCE
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
Accepted for publication JACC
PERCUTANEOUS PVL CLOSURELHH EXPERIENCE
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
Accepted for publication JACC
4D CTA and TRANSAPICAL ACCESS4D CTA and TRANSAPICAL ACCESS
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA and TRANSAPICAL ACCESS4D CTA and TRANSAPICAL ACCESS
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA and FLOUROSCOPIC COREGISTRATION
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA and TRANSAPICAL ACCESS
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA and TRANSAPICAL ACCESS
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
TRANS‐APICAL ACCESS FOR MITRAL PVL CLOSURE
140
160
100
120
140
nutes
40
60
80Min
0
20
40
C t d S i T h i Pl d TA
Procedural Time Fluoroscopy time
Converted Snair Technique Planned TA
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA AND TAVI4D CTA AND TAVI
TAVI Imaging Requirements
• FluoroscopyFluoroscopy
• TEE
• CTA coregistrationArterial puncture siteArterial puncture site
Precise deployment of CoreValve
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
4D CTA AND TAVI
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
THANK YOUTHANK YOU
Lenox Hill Heart and VascularInstitute of New York
Lenox Hill Heart and VascularInstitute of New York
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