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Key themes include adjunctive visualization advantages over TEE, the need for formal training to integrate imaging skills, and balancing improved access with safety outcomes for procedures such as TAVR and 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\nComing of Age: Facing Growing Pains in Structural Heart Interventions With Innovative Imaging Solutions  \n*  \nMegan Coylewright, MD, MPH  \nHeart and Vascular Center, Essentia Health, Duluth, Minnesota  \nEvidence that transcatheter structural heart disease therapies have come of age is in front of us: the focus of interventional cardiology is now on capacity and infrastructure over simply growth. The demand for mature therapies—including transcatheter aortic valve replacement, left atrial appendage occlusion (LAAO), and transcatheter edgeto-edge repair—may soon outstrip our human resources in many hospitals in the United States and thus requires thoughtful implementation of innovations in efficiency.  \nIn this context, the Society for Cardiovascular Angiography & Interventions (SCAI) provides a position statement on the use of intracardiac echocardiography (ICE) to guide structural heart interventions.1 This follows the recent 2025 SCAI/Heart Rhythm Society Clinical Practice Guidelines on Transcatheter LAAO and accompanying technical review, distinct documents involving review of the literature to describe the safety and efficacy of ICE for LAAO2,3; however, the current position statement provides a more comprehensive review of ICE for all structural heart interventions and provides some step-by-step guidance for interventional cardiologists (ICs) as their practices evolve to include this critical imaging modality. Structural heart ICs must consider several aspects regarding both why and how to consider integrating ICE into their practice.  \nAdjunctive visualization  \nLimitations exist in imaging from transesophageal echocardiography (TEE) based on unique patient anatomy in addition to the location of structures of interest (ie, anterior location of tricuspid valve) . For some patients, TEE can have higher complications, and case selection remains important.4 ICE can provide a closer, more nuanced view to cardiac structures needed to confirm positioning and safe implantation of devices.  \nThe position statement succinctly reviews the advantages and limitations of ICE for visualization in structural heart procedures, noting the rapid development of new imaging probes and software to improve images. While early experience with manipulation of ICE  \nprobes led to a low signal of increased pericardial effusion, the tools continue to become smaller and more flexible, and operator skill sets and awareness as volumes of cases increase drive safety.5,6  \nExpanding skill sets  \nMany ICs are less well versed in cardiac imaging compared with their highly refined procedural acumen. For many years, ICs have relied on their imaging colleagues not only to obtain images during structural heart procedures but also to provide nuanced interpretation and procedural guidance. For ICs to potentially transition to a dual role of implanter and imager requires formal and detailed training. This position statement is a small step to describe the differences and similarities for ICE across therapeutic areas and highlights that becoming a cardiac imager cannot be done ad hoc.  \nThe fact that specialized postfellowship training via literature review, procedural videos, courses, and proctoring is supported by this position statement highlights the unique aspects of integrating a new imaging modality into practice. For some interventionalists, imaging remains a softer skill set that proceduralists may feel they can learn on their own. Evidence from the very slow uptake of ICE to guide LAAO due to difficulty crossing the interatrial septum, concern about navigating the probe in the left atrium due to risk of pericardial effusion, and uncertainty in interpretation of a new set of images magnifies the importance of training to increase the speed of the learning curve and adoption while ensuring safe best practices.  \nFocus on both improved access and safety  \nICE","cbCaieaW4NPP4vUn","https://ap.wps.com/l/cbCaieaW4NPP4vUn","pdf",1661546,"English","# Editorial\n## Maturation of structural heart interventions\n## Role of intracardiac echocardiography (ICE)\n## Adjunctive visualization and limitations\n## Expanding skill sets and training\n## Improving access while maintaining safety","[{\"question\":\"What shift in focus do the authors describe for structural heart interventions?\",\"answer\":\"The editorial states that interventional cardiology is moving from simple growth toward capacity, infrastructure, and efficient implementation of mature therapies.\"},{\"question\":\"Why does the position statement emphasize intracardiac echocardiography (ICE)?\",\"answer\":\"ICE is presented as a guiding imaging modality that can provide closer, more nuanced visualization for positioning and safe implantation across structural heart procedures.\"},{\"question\":\"What is the main concern when adopting ICE into practice?\",\"answer\":\"The editorial highlights that efficiency must not override safety, and stresses formal training and awareness to build operator skill and support safe best practices.\"}]","Coming of Age: Facing Growing Pains in Structural Heart Interventions With Innovative Imaging Solutions - Editorial | PDF",1790680420]