ESC Rene Laennec Lecture in Clinical Cardiology
Transcatheter treatment of structural heart disease and the emergence of interventional imaging
30 Aug 2025
The presenter of today’s ESC Rene Laennec Lecture in Clinical Cardiology is Professor Rebecca Hahn (Columbia University Medical Centre - New York, USA), whose role as a pioneer and champion of interventional echocardiography has been instrumental in establishing this imaging subspeciality.
What are the key themes of your lecture?
Although interventional echocardiography only began to emerge as a distinct subspecialty around 15 years ago, interventional echocardiographers have quickly become essential members of the Heart Team. As well as being involved in all of the steps of the intervention itself, practitioners provide valuable clinical information from pre-procedural screening and post-procedural assessments. They also need to have a very broad range of expertise and core competencies.1 Not only do they require a detailed understanding of pathophysiology and the valve morphology, they also have to have a good knowledge of the huge number of devices available – how they work, how they should be deployed, how they should look in situ post-intervention – to ensure the success of the procedure. Device knowledge is particularly relevant within the area of tricuspid valve disease, which became the focus of my work in 2012. I was part of the team involved in the first in-human transcatheter tricuspid valve repair in Hamburg, Germany, in 2014,2 and there has since been a deluge of different tricuspid device investigations – all prompted by imaging and our understanding of how to guide the procedure.
What are the most important current opportunities and challenges?
Interventional echocardiography has tended to be underappreciated as a field in general, and within the cathlab in particular. Because it is a new and still relatively small area, it has sometimes been a struggle to ensure that its voice carries weight in decision-making. We need to highlight the fact that interventional echocardiography is a separate imaging subspecialty that requires a lot of additional training. At the moment, most practitioners are trained on the job. However, this means that the level of expertise gained is dependent very much on the volume of procedures carried out at their centre. At Columbia University, we have our own imaging fellowship and since 2012, around 18 fellows have graduated from this intensive, 1-year programme. Our aim is to try to build on this by helping to develop a national board certification for interventional echocardiography.
How do you think your field will evolve in the future?
The future for imaging is tremendous. We've never seen such an explosion of new technology before. Miniaturisation is a focus of much of the research, and one example of this is the development of a tiny intravascular probe for 3D intracardiac echocardiography as an alternative to the traditional transoesophageal probe. The availability of such a device will not only extend access to procedures for patients currently unable to undergo standard transoesophageal echocardiography, it may also simplify the process by removing the requirement for general anaesthesia.
Another exciting development is a new artificial intelligence-driven imaging software, which translates scans into 3D holographic cardiac images that can be rotated to allow viewing of different aspects from all angles. The rapid pace of innovation is set to make imaging easier and more accurate than ever before and will help to further establish the importance of the interventional echocardiographer within the Heart Team.
References
- Hahn RT, et al. JACC Cardiovasc Imaging. 2019;12:2560–2570.
- Schofer J, et al. J Am Coll Cardiol. 2015;65:1190–1195.
