4dcta for shd - summitmd.comsummitmd.com/pdf/pdf/1542_4dcta for shd.pdf · – director structural...

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 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



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)



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



4D CTA and Mitral PVL Closure4D CTA and Mitral PVL Closure



3D TEE and Mitral PVL Closure3D TEE and Mitral PVL Closure



PERCUTANEOUS PVL CLOSURELHH EXPERIENCE



Accepted for publication JACC

4D CTA and TRANSAPICAL ACCESS4D CTA and TRANSAPICAL ACCESS



4D CTA and FLOUROSCOPIC COREGISTRATION



4D CTA and TRANSAPICAL ACCESS



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



4D CTA AND TAVI4D CTA AND TAVI

TAVI Imaging Requirements

• FluoroscopyFluoroscopy

• TEE

• CTA coregistrationArterial puncture siteArterial puncture site

Precise deployment of CoreValve



4D CTA AND TAVI



THANK YOUTHANK YOU



4dcta for shd - summitmd.comsummitmd.com/pdf/pdf/1542_4dcta for shd.pdf · – director structural...

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