This is the 3rd dimension - increasing array of therapeutic options for patients. He highlighted the multitude of options for aortic & mitral valve interventions available today
Next was a presentation by former ESC President and multi-modality cardiac imager Dr Jeroen Bax, who discussed the role and place of the Heart Team in the guidelines
Dr Bax explained the changes between the 2017 & 2021 ESC guidelines on VHD...explaining the reasons for including Heart Team discussions - usually for the most complex cases or ones in which several treatment options exist
A great flowchart showing the flow of care between networks
Last year, the @BrHeartValveSoc produced its Blueprint which discussed the importance of network-based care. Not all hospitals / centres have all options and expertise - and they don't all need to!
Then a very interesting talk (for me!) on whether imaging still leads to best decisions for patients - pleased to hear early on a resounding Yes from Dr Unbehaun!
Great example relating to V-in-V TAVI...imaging can tell you likelihood of coronary obstruction and thus whether the #BASILICA technique will be required
Over 70 transcatheter devices on the market; none suitable for all patients...and no Dr can be expert in all of these...so, have to select the right device for the right patient to be done by right operator(s) in the right centre...and that'll need a Heart Team
Another nice example recently of the importance of a systematic approach to assessment of mitral regurgitation during TOE
Indication was known MR, assess suitability for TEER
Mid oesophageal 4Ch & 5Ch views...wondering if we have the right patient! No real MR to see...
The segmentation approach in the bicommisural view is a very reliable and easy-to-do method
Start at the lateral side of the valve with X-plane (Philips) / MultiD (GE) and you have A1-P1 coaptation on the right side...do this with 2D only & then with colour Doppler too
Then move to the middle of the valve with your cursor, cutting through A2 in bicomm view so you see A2-P2 coaptation on the right side
It takes time to read the paper, read the supplementary appendix, analyse the results, think about them etc!
Some thoughts...π§΅
On Sunday I wrote a thread about asymptomatic severe AS and what we knew already from RECOVERY & AVATAR RCTs and what the guidelines currently advocate
Transthoracic echocardiography (TTE), when performed with care and diligence, can reveal a lot about the valve. TOE isn't necessary in all cases to determine leaflet pathology.
A worked example below:
In the PLAX view, you can assess the scallops of the leaflets
In a true PLAX view with aortic valve clearly visible, you mostly see the A2-P2 interface. Here, you can see a clear & large prolapse of the posterior leaflet
If you tilt upwards towards the PLAX RV outflow (pulmonary valve) view you see mostly the A1-P1 interface
Here, you can see the valve looks slightly different & no prolapse is seen
PE has garnered a reputation for huge profits as they typically buy into a company, aggressively β¬οΈ costs whilst β¬οΈ profit margins, leverage debt if needed, and then sell, often at a large profit
Does this matter when it comes to delivering healthcare services?