Transcatheter direct annuloplasty has been introduced as a novel interventional treatment option for severe mitral valve regurgitation. Until now, only one direct annuloplasty device (Edwards Cardioband) has been commercially available, being implanted in more than 250 patients worldwide. Yet this procedure poses greater challenges regarding optimal fluoroscopic and echocardiographic guidance compared with edge-to-edge repair: correct localization and orientation of the anchors upon penetration into the fibrous mitral annulus tissue and the basal left ventricular myocardium are preconditions for an optimal result and essential to avoid damage of the neighboring structures (atrioventricular node, circumflex artery, coronary sinus). Real-time single-beat multiplanar reconstruction has become available as an additional imaging tool for three-dimensional transesophageal echocardiography in most recent echo machines. In this review, we introduce a three-dimensional transesophageal echocardiography-based imaging protocol implementing real-time multiplanar reconstruction for transcatheter direct annuloplasty procedures, which optimizes and also simplifies echocardiographic guidance during the implantation. The advanced echocardiographic protocol might also help to expedite implantation times and potentially increase the safety of the procedure. In this "how-to" article, we describe in detail this novel approach for optimized guidance and compare its advantages and challenges to "conventional" echocardiographic imaging for transcatheter mitral valve repair.

中文翻译：

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三维经食道超声心动图指导的高级协议，通过直接瓣环成形术对经导管二尖瓣修复进行实时多平面重建。

经导管直接瓣环成形术已被引入作为严重二尖瓣返流的新型介入治疗选择。到现在为止，只有一种直接的瓣环成形术设备（Edwards Cardioband）在市场上可以买到，并且被植入全球250多个患者中。然而，与边缘到边缘修复相比，此过程在最佳荧光检查和超声心动图引导方面提出了更大的挑战：锚定在穿透二尖瓣纤维环组织和左心室基底心肌时的正确定位和方向是获得最佳结果和必要条件的前提避免损坏邻近结构（房室结，回旋支，冠状窦）。实时单搏多平面重建已成为最新回波机器中三维经食管超声心动图检查的附加成像工具。在本文中，我们介绍了一种基于三维经食道超声心动图的成像方案，该方案可对经导管直接瓣环成形术实施实时多平面重建，从而优化并简化了植入过程中的超声心动图指导。先进的超声心动图协议还可能有助于加快植入时间，并可能增加手术的安全性。在这篇“操作方法”文章中，我们将详细介绍这种用于优化指导的新方法，并比较其对经导管二尖瓣瓣膜修复的“常规”超声心动图成像的优势和挑战。