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Page 8 of 12 Mestres et al. Vessel Plus 2019;3:38 I http://dx.doi.org/10.20517/2574-1209.2019.20

Figure 5. Echo/fluoro overlay of segmented 3D heart in fluoro space. TV: tricuspid valve; MV: mitral valve

Even with public funding, investigators may face problems with logistics and regulations that are a burden
for someone with suboptimal structure for execution of reserch projects. The European Union regulations
[52]
on research are an example of how complex and challenging the scenario becomes.

Transcatheter therapies came to stay and conventional surgery had to sustain the impact of this growing
and currently accepted approach to treat heart and vascular disease. There has been a paradigm shift in
[51]
therapeutic strategies; again, the example of transcatheter aortic valve implantation and transcatheter
[53]
repair of mitral insufficiency shows that adaptive change is required and surgery and the surgeons must
complete the initial efforts towards a full adoption of these technologies.

The same phenomenon has been observed in the field of Vascular Surgery. Once a fully open surgical
specialty, vascular surgeons converted the Specialty in a combined surgical activity, for which wire
skills became the routine. Thus, conventional surgery and transcatheter procedures are mixed and no
differentiation within the team is made.

The intellectual component
[54]
From all of the above one can infer that challenges are to be positively accepted. Form follows function
[55]
and this is why nature defined the evolution of species, as species undergo adaptive changes . A quick
look into different species heart morphology allows to understand why the heart has different forms and
[56]
sizes .