Haemodynamic instability and right ventricular dysfunction are the key determinants of short-term prognosis in patients with acute pulmonary embolism (PE). Residual thrombi and persistent right... Show moreHaemodynamic instability and right ventricular dysfunction are the key determinants of short-term prognosis in patients with acute pulmonary embolism (PE). Residual thrombi and persistent right ventricular dysfunction may contribute to post-PE functional impairment, and influence the risk of developing chronic thromboembolic pulmonary hypertension. Patients with haemodynamic instability at presentation (high-risk PE) require immediate primary reperfusion to relieve the obstruction in the pulmonary circulation and increase the chances of survival. Surgical removal of the thrombi or catheter-directed reperfusion strategies is alternatives in patients with contraindications to systemic thrombolysis. For haemodynamically stable patients with signs of right ventricular overload or dysfunction (intermediate-risk PE), systemic standard-dose thrombolysis is currently not recommended, because the risk of major bleeding associated with the treatment outweighs its benefits. In such cases, thrombolysis should be considered only as a rescue intervention if haemodynamic decompensation develops. Catheter-directed pharmaco-logical and pharmaco-mechanical techniques ensure swift recovery of echocardiographic and haemodynamic parameters and may be characterized by better safety profile than systemic thrombolysis. For survivors of acute PE, little is known on the effects of reperfusion therapies on the risk of chronic functional and haemodynamic impairment. In intermediate-risk PE patients, available data suggest that systemic thrombolysis may have little impact on long-term symptoms and functional limitation, echocardiographic parameters, and occurrence of chronic thromboembolic pulmonary hypertension. Ongoing and future interventional studies will clarify whether 'safer' reperfusion strategies may improve early clinical outcomes without increasing the risk of bleeding and contribute to reducing the burden of long-term complications after intermediate-risk PE. Show less
Recent advances in catheter-based interventions have provided effective alternative treatments to surgery for several structural heart diseases such as atrial or ventricular septal defects.... Show moreRecent advances in catheter-based interventions have provided effective alternative treatments to surgery for several structural heart diseases such as atrial or ventricular septal defects. Particularly, the advent of transcatheter valve implantation/repair techniques constitutes one of the main breakthroughs of the last decades offering an effective alternative to patients with symptomatic valvular heart disease and high mortality operative risk. In addition, the role of novel catheter-based interventions has been explored in several clinical conditions that convey an increased risk of cerebrovascular stroke such as patent foramen ovale or atrial fibrillation. Specific devices have been developed to treat all these clinical conditions. To improve the procedural success rate and minimize the frequency of complications, multimodality cardiac imaging plays a central role providing an accurate selection of patients and invaluable assistance during the procedure. Technological advances in the equipments and image post-processing softwares have provided improved accuracy of the image quality and analysis leading to an increasing implementation of these imaging techniques in the clinical practice. The present state-of-the-art article reviews the role of multimodality imaging for planning and guiding interventions in structural heart disease. Show less
