Training in structural heart disease imaging

Although training in multi-modality imaging has been well outlined, there are no specific training guidelines and/or requirements for SHD imagers as demonstrated by the results of a recent European survey. Some of the challenges currently faced by cardiology fellows who look for SHD imaging training include finding training centers with enough high-risk clinical volume and exposure to a variety of high-risk procedures so they can train beyond traditional TAVR procedures. This brings an inevitable question of whether adequate SHD imaging training should therefore be reserved to a small number of centers with sufficient knowledge and experience in these procedures. What should constitute the minimal portfolio of procedures, their degree of complexity, the number of cases performed for procedural planning and for intraprocedural guidance to achieve adequate proficiency are some of the questions whose answers remain unclear.

The majority of high-volume programs can provide comprehensive exposure for adequate training, particularly in TAVR, Atrial Septal Defect (ASD) and Left Atrial Appendage (LAA) closure procedures. Transcatheter mitral valve repair with MitraClip system (Abbott Vascular, Menlo Park, CA) is also becoming increasingly more commonly performed and should become a standard part of the SHD imager training. On the other hand, transcatheter procedures such as paravalvular leak closure, transcatheter mitral valve replacement and percutaneous tricuspid interventions are more complex and less frequently performed, and therefore should involve different expectations for what is considered the minimal requirement to achieve proficiency.

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