Exploring Echocardiography Innovations in Structural Heart Procedures

Sophisticated, real-time imaging during minimally invasive catheter-based procedures has opened the door to more treatment alternatives for heart patients who might have had few options in the past.

The continual advances in echocardiography are making it possible for more patients than ever to be treated with less invasive techniques for valve and structural heart problems.

Elliott Elias, M.D., medical director of cardiac and structural imaging for Baptist Health Miami Cardiac & Vascular Institute.

 

“We can accomplish so much with intraprocedural guidance — and that guidance is getting better and better,” says Elliott Elias, M.D., medical director of cardiac and structural imaging for Baptist Health Miami Cardiac & Vascular Institute.

Expanding Technology

Clinical trials and partnerships with medical manufacturers have resulted in pivotal advances in treating or replacing heart valves, while spurring the next generation of devices.

“Cardiac imaging is advancing as we figure out some of the nuances in a field that is constantly changing based on the new devices available,” Dr. Elias says.

One example is the TRILUMINATE trial, an international study evaluating a device for patients with severe regurgitation in the tricuspid valve. The research is continuing, but has enormous potential, Dr. Elias says. “I think that it’s going to really reshape the landscape of how we treat that particular valve.”

Initially, a lot of the innovation focus was on aortic valve repair, resulting in the minimally invasive procedure known as TAVR, transcatheter aortic valve replacement. Within one decade of its approval by the Food & Drug Administration, TAVR has become the predominant solution for patients with aortic valve problems.

“Now we’re working our way down to the mitral and tricuspid valves, which are more complex. I think in the next five to 10 years we’ll be able to do very similar things, and hopefully with similar outcomes, to avoid surgery when appropriate for those patients,” Dr. Elias says.

It’s an exciting time to be working in this field, says Dr. Elias, who will be moderating the 40th Annual Echocardiography and Structural Heart Symposium in September. The Symposium, to be held in Coral Gables, will include presentations by internationally renowned faculty from institutions throughout the country.

“Structural heart interventions continue to evolve. As we’ve found alternatives to surgery for high-risk patients, the treatments have been so good we can now offer them to intermediate and low-risk patients for certain conditions,” Dr. Elias says. “Our goal is to minimize the procedural risk and maximize how fast patients can leave the hospital and get back to their lives.”

Noteworthy Developments

Vital developments in structural heart procedures have been undertaken at Baptist Health Miami Cardiac & Vascular Institute under the direction of Ramon Quesada, M.D., medical director of Structural Heart and Complex Percutaneous Coronary Intervention. For example, Dr. Quesada and interventional cardiologist Bernardo Lopez-Sanabria, M.D., who both will present at the Symposium, have been utilizing the VeriSight system, the most advanced intracardiac ultrasound available.

Previous to VeriSight Pro, interventionalists had to rely primarily on transesophageal echocardiography (TEE) imaging performed before and after procedures. TEE requires general anesthesia as an ultrasound probe is passed down the patient’s throat and into their esophagus, until it lies next to the heart. TEE usually extends preparation, procedure and recovery times — while carrying a degree of risk.

VeriSight Pro uses the same ultrasound technology, miniaturized to fit on the tip of a 3 millimeter-in-diameter catheter and is navigated to the patient’s heart via the femoral vein in the leg — the same route used to introduce other catheters during minimally-invasive cardiac surgery. Physicians can digitally change the scan angle to capture views without manually repositioning the ultrasound tip. Other unique features of this catheter: It provides a 90- by 90-degree, 3D field of view, and it allows physicians to view two scan planes simultaneously during procedures.

“In the past, the limitation of the intracardiac ultrasound is that we didn’t have the three-dimensional imaging, or intracardiac ultrasound,” explains Dr. Quesada. “This new device, VeriSight Pro, changed that. It allows us to complete certain procedures without general anesthesia. That’s very, very important. And that’s very revolutionary. The imaging has improved dramatically.”

Additional advances include ever-improving 3D scans, fusion imaging software that overlays echocardiogram and X-ray scans in real time, and MRIs with artificial intelligence.

“This breakthrough technology means a significant benefit for patients,” says Constantino Pena, M.D., medical director of vascular imaging for the Institute.

And, adds Dr. Quesada, “The technology is only going getting better.”