Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions

Abstract

Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

“…Finally, intracardiac echocardiography (ICE) is an alternative imaging method of the LAA, usually indicated when TOE is contraindicated or not obtainable. ICE is performed with an 8–10 Fr catheter introduced through femoral venous access and advanced in right heart chambers under fluoroscopic guidance [38]. In the absence of interatrial transseptal crossing, the LAA can be displayed indirectly through the right ventricle outflow tract and the pulmonary artery, considering their close anatomical relationship [39].…”

Optimization of Echo Views for Percutaneous Device Closure of Pediatric Atrial Septal Defect through the Femoral Vein Guided by Transthoracic Echocardiography without Radiation

“…With the widespread use of the Amplatzer occluder and the rapid development of interventional techniques, traditional radiographically guided percutaneous interventional ASD closure has been proven to be a safe and effective method [ 1 , 2 ]. Some scholars [ 6 ] used intracardiac echocardiography to guide percutaneous transluminal atrial septal occlusion in the early years, but the cost of the corresponding catheter is not suitable for China's current national conditions. In recent years, to avoid radiation damage to patients and doctors, the use of echocardiography to gradually and completely replace radiation for interventional therapy has become an important method for improving traditional percutaneous interventional techniques [ 7 ].…”

“…After the position of the delivery sheath is determined, the relationship between the released device and surrounding structures can be effectively observed in combination with the four-chamber views, including the mitral valve and pulmonary veins, which ensures the safety of the device release and avoids the occurrence of complications. Furthermore, we avoid the use of harmful X-rays and expensive intracardiac ultrasound [ 6 ] to complete the entire occlusion procedure quickly and efficiently by minimizing the number of views conversions while ensuring the quality of the imaging, optimizing the process, and ensuring the quality of the procedures.…”

Intracardiac echocardiography to guide catheter ablation of an accessory pathway in Ebstein’s anomaly. A case report

“…On the contrary, in our patient we used the ViewFlex Xtra catheter that has a large curvature radius with different steering angles from 0 to 120 degrees with a simple onehand torsional control. The ViewMate Zonare console operates in different modes for high resolution 2D imaging of cardiac structures with intuitive on-screen menus for color, pulsed and continuous Doppler [9]. As the above mentioned authors did, we identified the anatomical tricuspid annulus with the help of ICE and ablated the accessory pathway using radiofrequency applications.…”