Feasibility of multiplane microtransoesophageal echocardiographic guidance in structural heart disease transcatheter interventions in adults

Abstract

IntroductionStructural heart interventions are guided by transoesophageal or intracardiac echocardiography (TEE/ICE). MicroTEE, developed for paediatric purposes, is smaller and therefore less invasive and traumatic, avoiding the need for general anaesthesia. We aimed to show feasibility of procedural guidance by comparing image quality of microTEE with standard TEE and ICE during adult transcatheter interventions, and assess the accuracy in obtaining left atrial appendage (LAA) measurements between the microTEE probe and standard TEE.Methods and resultsWe prospectively included 49 patients (20 women, 64 ± 18 years). Intraprocedural images were obtained by using the microTEE probe and standard (2D and 3D) TEE (LAA closure, MitraClip implantation) or ICE (interatrial communication closure, transseptal puncture for left atrial ablation). Two echocardiographers independently assessed image quality from 1 (excellent) to 4 (poor) and performed LAA measurements. Use of microTEE was not related to significant discomfort. Image quality obtained with the microTEE probe was lower than with standard TEE (2 [1–2] vs. 1 [1–2]; p = 0.04) and comparable with ICE images (2 [1–2] vs. 2 [1–2], p = 0.13). MicroTEE showed a wider field of view than ICE. LAA measurements on images obtained by microTEE were strongly associated with standard TEE.ConclusionsMicroTEE seems feasible for guidance during transcatheter heart interventions in adults. MicroTEE imaging offers a wider field of view than ICE, and its accuracy is comparable with TEE. In transcatheter interventions performed under conscious sedation, microTEE might be a viable and advantageous alternative to standard TEE or ICE.

Microtransesophageal Echocardiographic Guidance during Percutaneous Interatrial Septal Closure without General Anaesthesia

“…It is possible that the difference in image quality might cause undersizing or incorrect positioning of the device. However, previous studies did not find a difference in image quality during cardiac procedures [ 8 , 9 ]. More studies are needed to show if there is an actual difference.…”

“…Image quality was comparable between micro-TEE and ICE, and the accuracy of micro-TEE is comparable to TEE. An important difference between TEE and micro-TEE is that micro-TEE has no three-dimensional view possibilities, which could help in sizing the defect and positioning the device [ 8 ]. Klett et al compared micro-TEE and TEE as well during different types of interventions (transfemoral aortic valve implantation, transfemoral mitral valve implantation, and ASD and PFO closure).…”

“…The centre frequency is 6 MHz on a bandwidth of 3.2–7.4 MHz. Nijenhuis et al described other specifications previously [ 8 ]. Both image modalities are presented in Figures 1 and 2 .…”

“…Microprobe TEE (micro-TEE) has proven to be safe and effective during transcatheter cardiac interventions in neonates and infants since 2009 [ 5 – 7 ]. More recently, micro-TEE is safely used in adults as well [ 8 , 9 ]. Using a significantly smaller probe makes general anaesthesia not necessary, which might result in fewer complications.…”

4D Volume Intracardiac Echocardiography for Intraprocedural Guidance of Transcatheter Left Atrial Appendage Closure

“…Standard intraprocedural guidance for transcatheter left atrial appendage closure (LAAC) employs a multi-modality integrated approach combining fluoroscopy for guiding the delivery system, and transesophageal echocardiography (TEE) for intracardiac characterization to guide device selection and monitor procedural complications [1][2][3][4][5][6] . Successful implantation of the device is confirmed with contrast-enhanced fluoroscopy and color Doppler flow imaging on TEE.…”