Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: Feasibility and comparison with transesophageal echocardiography

Abstract

Transesophageal echocardiography (TEE) has been employed successfully for guiding transcatheter device closure of secundum atrial septal defect (ASD) and patent foramen ovale (PFO). However, the use of TEE for device closure requires general anesthesia. Intracardiac echocardiography (ICE) can provide similar anatomical views that might replace the use of TEE for device closure. Eleven patients (eight female/three male) with secundum ASD and PFO associated with strokes underwent attempts at transcatheter closure of their defects under sequential TEE and ICE guidance (six patients) and under ICE alone (five patients). The ages of the patients ranged from 6.6 to 74.7 yr, and their weights ranged from 23 to 124.5 kg. The sizes of the defects, as measured by TEE (six patients), ranged from 3 to 27 mm and, as measured by ICE (11 patients), from 3 to 27 mm. The balloon-stretched diameter of the ASD, as measured by TEE (six patients), ranged from 16 to 38 mm and, as measured by ICE (11 patients), from 16 to 35 mm. Both techniques correlated well for the measured two-dimensional diameter and for the balloon-stretched diameter (r ‫؍‬ 0.97 and 0.98, respectively). Both TEE and ICE provided similar views of the defects and the various stages of device deployment. Owing to the proximity of the left atrium to the esophagus, however, the images obtained by ICE were more helpful and informative than those obtained by TEE. All patients experienced successful device placement (six patients under both TEE and ICE; five patients under ICE guidance alone); complete closure of the defects was effected in nine patients, whereas two patients had small residual shunts. There were no complications. We conclude that ICE provides unique images of the atrial communications and measurements similar to those obtained by TEE. ICE potentially could replace TEE as a guiding imaging tool for ASD and PFO device closure, thus eliminating the need for general anesthesia.

Intracardiac echocardiography: gross anatomy and magnetic resonance correlations and validations

“…Therefore, mechanical ICE might be considered an active investment in cardiac catheterization laboratories, specifically in the percutaneous interventional procedure setting, discovering a new route (let's see and treat) to sophisticated interventions. In this respect, there can be little doubt that the knowledge of cross-sectional mechanical ICE imaging provides the basis for understanding the heart anatomy.Nowadays, intracardiac echocardiography (ICE) is a widespread approach in many cardiovascular procedures including transseptal left heart catheterization [1,2] or catheter placement [3][4][5], radiofrequency catheter ablation of cardiac arrhythmias [6][7][8], and transcatheter closures of atrial septal defect [9][10][11] or patent foramen ovale [9,12]. In all these procedures, ICE provides a far more adequate imaging of atrial architecture and more accurate information regarding the devices and catheter positions, resulting in improved safety and accuracy of the procedure itself.…”

“…Nowadays, intracardiac echocardiography (ICE) is a widespread approach in many cardiovascular procedures including transseptal left heart catheterization [1,2] or catheter placement [3][4][5], radiofrequency catheter ablation of cardiac arrhythmias [6][7][8], and transcatheter closures of atrial septal defect [9][10][11] or patent foramen ovale [9,12]. In all these procedures, ICE provides a far more adequate imaging of atrial architecture and more accurate information regarding the devices and catheter positions, resulting in improved safety and accuracy of the procedure itself.…”

The Utility of Intracardiac Echocardiography Following Melody™ Transcatheter Pulmonary Valve Implantation

“…ICE provides excellent real-time near and far-field imaging of cardiac structures, allows for continuous monitoring with minimal interference with the ongoing intervention, and has the potential to reduce overall cost of cardiac interventions by improving efficiency and need for repeat interventions [1,11,12]. The clinical applications of ICE in this setting are broad [2] and include guidance during transseptal puncture [8,12], balloon valvuloplasty of the mitral valve [9], interventional electrophysiology procedures [11][12][13], atrial septal defect device closure [4,10], and, more recently, transcatheter aortic valve replacement [5].…”

Impact of intracardiac echocardiography on radiation exposure during adult congenital heart disease catheter-based interventions

“…Nowadays, intracardiac echocardiography (ICE) is a widespread approach in many cardiovascular procedures including transseptal left heart catheterization [1] or catheter placement [2], radiofrequency catheter ablation of cardiac arrhythmias [3], transcatheter closures of atrial septal defect [4] or patent foramen ovale [5], and in general in complex congenital and cardiovascular percutaneous interventions [6,7]. In all these procedures, ICE provides a far more adequate imaging of atrial architecture and more accurate information regarding the devices and catheter positions, resulting in improved safety and accuracy of the procedure itself, with the potential to reduce the fluoroscopy time and patients radiation exposure.…”