Cardiac computed tomography (CT) is increasingly used to plan transcatheter structural heart interventions, however, intra-operative guidance relies on trans-esophageal echocardiography (TEE) and fluoroscopy. This study sought to develop the methods of stepwise CT multi-planar reconstruction manipulation to mimic TEE thus bridging the gap between preoperative planning and intra-operative guidance tools. This CT manipulation successfully reproduces similar configurations as TEE views in mid-esophageal left ventricle (LV) views, transgastric LV 2-chamber views for mitral apparatus, and other miscellaneous views. Stepwise cardiac CT manipulation to mimic TEE is the final piece of the puzzle in the mental co-registration of these three crucial imaging modalities. With it, we are enabled to foresee the TEE images and fluoroscopy projections in a preoperative rehearsal thus improving the intra-operative accuracy of interventions.

Objectives The impact of the COVID 19 pandemic on the treatment of patient with aortic valve stenosis is unknown and there is uncertainty on the optimal strategies in managing these patients. Methods This study is supported and endorsed by the Asia Pacific Society of Interventional Cardiology. Due to the inability to have face to face discussions during the pandemic, an online survey was performed by inviting key opinion leaders ( cardiac surgeon/interventional cardiologist/echocardiologist) in the field of transcatheter aortic valve implantation (TAVI) in Asia to participate. The answers to a series of questions pertaining to the impact of COVID-19 on TAVI were collected and analyzed. These led subsequently to an expert consensus recommendations on the conduct of TAVI during the pandemic Results The COVID 19 pandemic had resulted in a 25% (10-80) reduction of case volume and 53% of operators required triaging to manage their patients with severe aortic stenosis. The two most important parameters used to triage were symptoms and valve area. Periprocedural changes included the introduction of teleconsultation, pre-procedure COVD 19 testing, optimization of pre-tests and catheterization laboratory set up. In addition, length of stay was reduced from a mean of 4.4 to 4 days. Conclusion The COVID-19 pandemic has impacted on the delivery of TAVI services to patients in Asia. This expert recommendations on best practices may be a useful to guide to help TAVI teams during this period until a COVID 19 vaccine becomes widely available