Cardiovascular Business - July/August 2008 - (Page 16)

Technology UpdaTe nation in aortic stenosis and intracardiac pressure determination. Now they are adopting live 3D TEE, specifically for aortic disease, endocarditis, left atrial disease and mitral valve disease— “everything in the posterior aspect of the heart,” says Emory’s Martin. He adds that 3D TEE has already become a standard tool for surgeons, having already encountered some who will not operate without pre-, intra-, and post-operative 3D TEE imaging, especially for valvular heart disease. Lang and colleagues have routinely performed real-time 3D TEE (iE33 Echocardiography System, Philips) on more than 700 cases. One of the main advantages of live 3D TEE is its “surgeon’s eye” view of the cardiac anatomy, says Lang. He agrees that the technique is finding a niche in preoperative planning, particularly for percutaneous mitral valve repair, and as a guiding tool in the cath lab during percutaneous procedures such as atrial septal defect (ASD) closures. A lack of indications and inadequate reimbursement for 3D echo are stumbling blocks for wholesale adoption. Medicare currently pays for two indications: estimation of the mitral valve orifice area and preoperative planning of mitral valve surgery. Lang would like to see the quantification of left ventricular ejection fractions and volumes added to the list. He says the ASE is working with the government to secure adequate reimbursement and additional indications for 3D echo. Lang and others are quick to point out that 2D echo remains the first line of investigation in most cases. Three-dimensional studies are done only when cardiologists believe they can get added information. Not just your father’s probe Henry Issenberg, MD, director of the Pediatric Echocardiography Laboratory at the Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, N.Y., has been performing real-time 3D TTE with the Philips system for about one year He says the journey from 2D echo with color flow to 3D echo “gives us more information to spatially look at the heart in ways we had never been able to do except in the post-mortem laboratory with the heart in your hand.” Pediatric cardiac diseases are mostly congenital structural real-time 3D transesophageal echo images of the heart of a four-month-old child with defects in the atrial and ventricular septa, and a common, single atrioventricular valve. systolic (top) and diastolic (botom) frames through the plane of the common atrioventricular valve, looking from the ventricular side toward the cardiac base. During diastole, the right and left atrium are visualized with a large primum atrial septal defect. source: Henry issenberg, MD, Maria Fareri Children’s Hospital, Valhalla, N.y. 16 cardiovascular Business July/august 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - July/August 2008

Cardiovascular Business - July/August 2008 Table of Contents First Word Cover Story: Planning for the Ideal Cath Lab Requires the Multidisciplinary Approach Clinical Study Digest: Cell Phone Technology Speeds Ecgs As Real-Time 3d Echo Matures, It Finds a Clinical Niche Ecg Image Management Brings Increased Productivity and Confidence Overcoming Barriers to Cath Lab Inventory Control Maximizing Reimbursement, Minimizing Penalties News & Views Calendar Reader Resources The Back Page

Cardiovascular Business - July/August 2008

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