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De Cillis E, Acquaviva T, Ursi R, Soldato N, Basile P, Siena P, Carella MC, Baggiano A, Mushtaq S, Fusini L, Rabbat MG, Pontone G, Bottio T, Bortone AS, Ciccone MM, Milano AD, Guaricci AI. A comparison of intracardiac echocardiography and transesophageal echocardiography for guiding device closure of ostium secundum atrial septal defect: A 15-year experience. Echocardiography 2024; 41:e15724. [PMID: 38064288 DOI: 10.1111/echo.15724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/03/2023] [Accepted: 11/19/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND AIM Our aim was to evaluate the fluoroscopy time (FT), procedure time (PT) safety and efficacy when using intracardiac echocardiography (ICE) in comparison to transesophageal echocardiography (TEE) guidance for transcatheter closure of Ostium Secundum Atrial Septal Defect (OS-ASD). METHOD Ninety patients (n = 90) diagnosed with OS-ASD underwent transcatheter closure between March 2006 and October 2021. Fifty-seven patients were treated under ICE guidance, while 33 patients were treated under TEE guidance. RESULTS Mean age was 43 ± 15 years and 42 ± 10 years in the ICE and TEE groups, respectively. The majority of patients had a centrally placed defect. Median FT was 8.40 min versus 11.70 min (p < .001) in the ICE group compared to the TEE group, respectively. Median PT was 43 min versus 94 min (p < .001) in the ICE group compared to the TEE group, respectively. Both ICE and TEE provided high quality images. All interventions were completed successfully, except for one patient in the ICE group who experienced a device migration, the development of atrial tachycardia in one patient and atrial fibrillation in two patients in the ICE group which spontaneously cardioverted. There were no other complications. CONCLUSION This study on a consistent cohort of patients with OS-ASD undergoing percutaneous closure suggests that use of ICE is safe and efficacious. Compared to TEE, ICE demonstrated significantly shorter FT and PT, decreasing the entire duration of the procedure and x-ray exposure. No relevant differences were observed in terms of success rate and complications.
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Affiliation(s)
- Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Tommaso Acquaviva
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Raffaella Ursi
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Nicolò Soldato
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Basile
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Paola Siena
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, Illinois, USA
- Division of Cardiology, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Tomaso Bottio
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Marco Matteo Ciccone
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Aldo Domenico Milano
- Division of University Heart Surgery, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
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2
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English CW, Rogers JH, Smith TW. Intracardiac Echocardiographic Guidance for Structural Heart Procedures: Current Utility as Compared to Transesophageal Echocardiography. Interv Cardiol Clin 2024; 13:39-49. [PMID: 37980066 DOI: 10.1016/j.iccl.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Over the past decade, engineering advances in intracardiac echocardiography (ICE) have improved the ability of an imager or interventionalist to guide not only interatrial septal procedures but now commonly left atrial appendage, tricuspid, and mitral procedures. When transesophageal echocardiography (TEE) is not possible because of anatomic limitations, ICE has proved a useful tool to safely complete structural interventions. ICE will play a growing, key role in structural interventions where anatomic factors strongly favor an intracardiac perspective or augment TEE when imaging is suboptimal.
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Affiliation(s)
- Carter W English
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA
| | - Thomas W Smith
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA.
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3
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Zeng R, Pu X, Chen S, Chen C, Chen Y, Chen W, Fu H. Oropharynx pain, discomfort, and economic impact of transesophageal echocardiography for planned radio-frequency catheter ablation in patients with atrial fibrillation: A cross-sectional survey study. IJC HEART & VASCULATURE 2023; 48:101266. [PMID: 37719868 PMCID: PMC10500450 DOI: 10.1016/j.ijcha.2023.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023]
Abstract
Background To survey the unmet medical needs associated with atrium thrombus screening in Chinese patients with atrial fibrillation (AF) who underwent transesophageal echocardiography (TEE) for planned radio-frequency catheter ablation (RFCA). Methods This cross-sectional survey study interviewed 300 patients who underwent their first TEE for planned RFCA. The surveyed information included patients' anxiety, oropharynx pain and discomfort, time expense, and patient satisfaction related to TEE examination. Patient preference for a new atrium thrombus screening technology, hospital length of stay (LOS) of RFCA, and hospital costs of RFCA in these surveyed patients were collected as well. Descriptive statistical methods were used to summarize the collected survey information. Results Of the 300 interviewed patients, 36.3% reported anxiety before TEE examination, 58.6% reported oropharynx pain related to TEE, and 76.2% reported oropharynx discomforts, mainly including foreign body sensation (54.3%), dry heaves (33.8%), nausea (31.9%), and bleeding (22.9%). Even though 62.3% were satisfied with TEE, 84.3% preferred a new technology to replace TEE. Conducting outpatient TEE took more wait time (4.4 days vs. 0.1 days, p = 0.016) but led to significantly shorter hospital LOS (3.8 days vs. 6.4 days, p < 0.001) and significant lower hospital costs for RFCA (¥74,097 vs. ¥85,843, p < 0.001) than conducting inpatient TEE. Conclusions Most AF patients experienced oropharynx pain and discomfort during or after TEE. Although more than half of AF patients were satisfied with TEE, most AF patients preferred a new technology to replace TEE for atrium thrombus screening. TEE was associated with economic impact on RFCA irrespective of TEE conducting settings.
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Affiliation(s)
- Rui Zeng
- West China Hospital of Sichuan University, Chengdu, China
| | - Xiaobo Pu
- West China Hospital of Sichuan University, Chengdu, China
| | - Shi Chen
- West China Hospital of Sichuan University, Chengdu, China
| | - Chunjia Chen
- Changsha Normin Health Technology Ltd., Changsha, China
| | - Yi Chen
- Changsha Normin Health Technology Ltd., Changsha, China
| | - Wendong Chen
- Normin Health Consulting Ltd., Mississauga, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Hua Fu
- West China Hospital of Sichuan University, Chengdu, China
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Tanabe Y, Takahara M, Kohsaka S, Shinke T, Takamisawa I, Amano T, Kanazawa H, Suzuki T, Kuwata S, Ishibashi Y, Akashi YJ, Ikari Y. Intracardiac Echocardiography Guidance for Percutaneous Transcatheter Closure of Atrial Septal Defects - Nationwide Registry Data Analysis. Circ J 2023; 87:517-524. [PMID: 36624061 DOI: 10.1253/circj.cj-22-0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Transesophageal echocardiography (TEE) has been used for percutaneous atrial septal defect (ASD) closure, with intracardiac echocardiography (ICE) guidance recently being introduced.Methods and Results: The Japanese Structural Heart Disease Registry was established by the Japanese Association of Cardiovascular Intervention and Therapeutics. This study analyzed data from the Registry for 2,859 consecutive cases undergoing percutaneous ASD closure between January 2015 and December 2020. ASD closure was performed under ICE guidance (n=519; 18.2%), TEE guidance (n=1,428; 49.9%), or TEE plus ICE guidance ("Both"; n=900 cases; 31.5%). The success rates were similar in the TEE, ICE, and both groups (99.0%, 99.2%, vs. 98.0%, respectively; P=0.054), as were complication rates (1.2%, 0.5%, vs. 2.1%, respectively; P=0.24). In the TEE and Both groups, 92.4% and 79.6% of patients required general anesthesia, compared with only 2.9% of patients in the ICE group (P<0.001). Fluoroscopic time was longer in the ICE and Both groups than in the TEE group (median [interquartile range] 19 [14-28] and 21 [13-30] vs. 12 [8-19] min, respectively; P<0.001). Rim deficiency and larger defect diameter were inversely related, whereas hospital volume was positively related to ICE guidance. CONCLUSIONS Percutaneous transcatheter ASD closure was as feasible under ICE as under TEE guidance. ICE guidance is used for less challenging cases in high-volume centers in Japan.
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Affiliation(s)
- Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | | | | | | | - Tomomi Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yuji Ikari
- Division of Cardiology, Tokai University School of Medicine
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Jingquan Z, Deyong L, Huimin C, Hua F, Xuebin H, Chenyang J, Yan L, Xuebin L, Min T, Zulu W, Yumei X, Jinlin Z, Wei Z, Xiaochun Z, Daxin Z, Yun Z, Changsheng M, Zei PC, Di Biase L. Intracardiac echocardiography Chinese expert consensus. Front Cardiovasc Med 2022; 9:1012731. [PMID: 36277762 PMCID: PMC9584059 DOI: 10.3389/fcvm.2022.1012731] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, percutaneous catheter interventions have continuously evolved, becoming an essential strategy for interventional diagnosis and treatment of many structural heart diseases and arrhythmias. Along with the increasing complexity of cardiac interventions comes ever more complex demands for intraoperative imaging. Intracardiac echocardiography (ICE) is well-suited for these requirements with real-time imaging, real-time monitoring for intraoperative complications, and a well-tolerated procedure. As a result, ICE is increasingly used many types of cardiac interventions. Given the lack of relevant guidelines at home and abroad and to promote and standardize the clinical applications of ICE, the members of this panel extensively evaluated relevant research findings, and they developed this consensus document after discussions and correlation with front-line clinical work experience, aiming to provide guidance for clinicians and to further improve interventional cardiovascular diagnosis and treatment procedures.
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Affiliation(s)
- Zhong Jingquan
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China,*Correspondence: Zhong Jingquan,
| | - Long Deyong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China,Long Deyong,
| | - Chu Huimin
- Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Fu Hua
- West China Hospital, Sichuan University, Chengdu, China
| | - Han Xuebin
- The Affiliated Cardiovascular Hospital, Shanxi Medical University, Taiyuan, China
| | - Jiang Chenyang
- Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Li Yan
- Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Li Xuebin
- Peking University People’s Hospital, Beijing, China
| | - Tang Min
- Fuwai Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang Zulu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Xue Yumei
- Guangdong Provincial People’s Hospital, Guangzhou, China
| | | | - Zhang Wei
- Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | | | - Zhou Daxin
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhang Yun
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ma Changsheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Paul C. Zei
- Brigham and Women’s Hospital, Boston, MA, United States
| | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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6
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Role of Echocardiography in the Diagnosis and Interventional Management of Atrial Septal Defects. Diagnostics (Basel) 2022; 12:diagnostics12061494. [PMID: 35741304 PMCID: PMC9222141 DOI: 10.3390/diagnostics12061494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
This review centers on the usefulness of echo-Doppler studies in the diagnosis of ostium secundum atrial septal defects (ASDs) and in their management, both in children and adults. Transthoracic echocardiography can easily identify the secundum ASDs and also differentiate secundum ASDs from other kinds of ASDs, such as ostium primum ASD, sinus venosus ASD and coronary sinus ASD, as well as patent foramen ovale. Preliminary selection of patients for device occlusion can be made by transthoracic echocardiograms while final selection is based on transesophageal (TEE) or intracardiac (ICE) echocardiographic studies with optional balloon sizing of ASDs. TEE and ICE are extremely valuable in guiding device implantation and in evaluating the position of the device following its implantation. Echo-Doppler evaluation during follow-up is also useful in documenting improvements in ventricular size and function, in assessing the device position, in detecting residual shunts, and in identifying rare device-related complications. Examples of echo images under each section are presented. The reasons why echo-Doppler is very valuable in diagnosing and managing ASDs are extensively discussed.
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Turner ME, Bouhout I, Petit CJ, Kalfa D. Transcatheter Closure of Atrial and Ventricular Septal Defects: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:2247-2258. [PMID: 35654496 DOI: 10.1016/j.jacc.2021.08.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
The field of congenital interventional cardiology has experienced tremendous growth in recent years. Beginning with the development of early devices for transcatheter closure of septal defects in the 1970s and 1980s, such technologies have evolved to become a mainstay of treatment for many atrial septal defects (ASDs) and ventricular septal defects (VSDs). Percutaneous device closure is now the preferred approach for the majority of secundum ASDs. It is also a viable treatment option for selected VSDs, though limitations still exist. In this review, the authors describe the current state of transcatheter closure of ASDs and VSDs in children and adults, including patient selection, procedural approach, and outcomes. Potential areas for future evolution and innovation are also discussed.
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Affiliation(s)
- Mariel E Turner
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA.
| | - Ismail Bouhout
- Division of Cardiothoracic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - David Kalfa
- Division of Cardiothoracic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
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8
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Rigatelli G, Gianese F, Zuin M. Secundum atrial septal defects transcatheter closure: An updated reappraisal. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:92-97. [PMID: 35680528 DOI: 10.1016/j.carrev.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
Transcatheter device-based closure is considered the first line therapy for congenital secundum atrial septal defect (ASD). The last 20 years literature data have been reviewed to offer an updated reappraisal of current evidences. Anatomical and functional details, appreciated at both pre-procedural and intraprocedural steps, remain of paramount importance for planning ASD transcatheter -based closure procedure. Routes for interventions should include femoral, and eventually the jugular and hepatic vein approaches. Intraprocedural transoesophageal echocardiography (TTE) or intracardiac echocardiography (ICE) is used at least in most complex cases to have the exact definition of the anatomy of the defects. The clinical outcomes are excellent also compared to surgical series with few complications even compare to surgical series. Transcatheter ASD closure represents the first line therapy in secundum ASD. Future developments of device's material and imaging tools are expected to improve safety and long-term efficacy, even in most complex cases.
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Affiliation(s)
| | - Filippo Gianese
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
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9
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Seol JH, Kim AY, Jung SY, Choi JY, Park YJ, Jung JW. Intracardiac Echocardiogram: Feasibility, Efficacy, and Safety for Guidance of Transcatheter Multiple Atrial Septal Defects Closure. J Clin Med 2022; 11:2394. [PMID: 35566520 PMCID: PMC9100238 DOI: 10.3390/jcm11092394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to determine the feasibility, efficacy, success, and safety of intracardiac echocardiography (ICE) in transcatheter multiple atrial septal defect (ASD) closure. Of 185 patients with multiple ASDs who underwent transcatheter closure, 140 (76%) patients who weighed <30kg with a narrow distance between defects or in whom single device closure was anticipated were guided by ICE and 45 patients were guided by three-dimensional (3D) transesophageal echocardiography (TEE) with or without ICE. Patients in the ICE group were relatively younger and weighed less than those in the 3D TEE group (p < 0.0001). The ratio of the distance between defects >7 mm was high, and more cases required ≥2 devices in the 3D TEE group than those in the ICE group (p < 0.0001). All patients in the 3D TEE group and seven patients (5%) in the ICE group were operated on under general anesthesia (p < 0.0001). The fluoroscopic time was shorter in the ICE group (13.98 ± 6.24 min vs. 24.86 ± 16.47 min, p = 0.0005). No difference in the complete closure rate and complications was observed. ICE-guided transcatheter and 3D TEE were feasible, safe, and effective in successful multiple ASD device closures, especially for young children and patients at high risk under general anesthesia.
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Affiliation(s)
- Jae-hee Seol
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26493, Korea
| | - Ah-young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
| | - Se-yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
| | - Jae-young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
| | - Yeon-jae Park
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju 26493, Korea;
| | - Jo-won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
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10
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Baseline intracardiac echocardiography predicts haemodynamic changes and Doppler velocity patterns during follow-up after percutaneous pulmonary valve implantation. Cardiol Young 2022; 32:444-450. [PMID: 34140059 DOI: 10.1017/s1047951121002365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intracardiac echocardiography Doppler-derived gradients have previously been shown to correlate with post-procedure echocardiographic evaluations when compared with invasive gradients measured during percutaneous pulmonary valve implantation, suggesting that intracardiac echocardiography could offer an accurate and predictable starting point to estimate valve function after percutaneous pulmonary valve implantation. METHODS We performed a retrospective chart review of 51 patients who underwent percutaneous pulmonary valve implantation between September 2018 and December 2019 in whom intracardiac echocardiography was performed immediately after valve implantation. We evaluated the correlation between intracardiac echocardiography gradients and post-procedural Doppler-derived gradients. Among the parameters assessed, those which demonstrated the strongest correlation were used to create a predictive model of expected echo-derived gradients after percutaneous pulmonary valve implantation. The equation was validated on the same sample data along with a subsequent cohort of 25 consecutive patients collected between January 2020 and July 2020. RESULTS All the assessed correlation models between intracardiac echocardiography evaluation and post-procedure transthoracic echocardiographic assessments were statistically significant, presenting moderate to strong correlations. The strongest relationship was found between intracardiac echocardiography mean gradients and post-procedural transthoracic echocardiographic mean gradients. Therefore, an equation was created based on the intracardiac echocardiography-derived mean gradient, to allow prediction of the post-procedural and follow-up transthoracic echocardiographic-derived mean gradients within a range of ±5 mmHg from the observed value in more than 80% of cases. CONCLUSIONS There is a strong correlation between intracardiac echocardiography and post-procedure transthoracic echocardiographic. This allowed us to derive a predictive equation that defines the expected transthoracic echocardiographic Doppler-derived gradient following the procedure and at out-patient follow-up after percutaneous pulmonary valve implantation.
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11
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Baykan A, Bilici M, Narin N, Erdem A, Uzum K, Akin A, Pamukcu O, Balik H, Ture M, Vural C, Dogan A. Percutaneous Closure of Atrial Septal Defects with the MemoPart Atrial Septal Occluder: The Early-Term Results of a Multicenter Study. Pediatr Cardiol 2022; 43:39-44. [PMID: 34401943 DOI: 10.1007/s00246-021-02688-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
Atrial septal defect (ASD) is a common congenital heart disease with left-to-right shunt that may lead to pulmonary hypertension over time. Secundum ASD closure with transcatheter technique is currently the preferred method. The aim of this study was to evaluate the clinical experience and early-term outcomes of patients treated with a MemoPart ASD occluder device between June 2013 and June 2019. Fifty-six patients (35 females) with a mean age of 9.4 ± 6.6 years (range: 2-44 years) were included in the study. The diameters of the devices used to close the ASDs were 7-28 mm. The ratio of the device/defect diameter was 1.14:1. Atrial septal defect closure was applied successfully in all patients. The MemoPart septal occluder is a safe and effective device for ASD closure. In wide ASDs and cases with more than one deficient rim, weak rims, or wide and complicated cases, it can be used carefully with sufficient experience.
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Affiliation(s)
- Ali Baykan
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Meki Bilici
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Diyarbakır, Turkey. .,VM Medical Park Kocaeli Hastanesi, Ovacık Mah. D 100 Karayolu üzeri, Başiskele, Kocaeli, Turkey.
| | - Nazmi Narin
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Abdullah Erdem
- Department of Pediatric Cardiology, Medipol University Medical Faculty, İstanbul, Turkey
| | - Kazim Uzum
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Alper Akin
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Ozge Pamukcu
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hasan Balik
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Mehmet Ture
- Department of Pediatric Cardiology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Cagdas Vural
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Alper Dogan
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
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Vanreusel I, Maes S, De Wolf D, Van Berendoncks A. Percutaneous closure of a secundum atrial septum defect performed under hypnosis: a case report. Acta Cardiol 2021; 76:1078-1082. [PMID: 32964783 DOI: 10.1080/00015385.2020.1822491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Atrial septal defects (ASDs) are the third most common type of congenital heart diseases with ostium secundum defects (ASDsII) being responsible for approximately 75% of these defects. The treatment consists of either a transcatheter closure or a surgical intervention. The transcatheter approach offers a less invasive alternative for patients who fulfill anatomical and size criteria and is therefore increasingly used as the preferred primary intervention. As general anaesthesia is sometimes contra-indicated for some patients needing ASD or PFO closure and intracardiac echocardiography (ICE) is not always readily available, alternative "supportive" techniques as hypnosis could be of interest. In our case, a relative contra-indication for general anaesthesia was pronounced due to the severely impaired pulmonary function caused by severe deformative torsional scoliosis. Over the years several reviews have been published on hypnotic analgesia used together with usual care suggesting that hypnotic analgesia is a promising non-pharmacologic adjunct treatment for ameliorating pain and surgical distress. Also, various cardiological procedures under hypnosis have already been described in literature, but this is the first time that percutaneous ASD closure under virtual reality (VR) hypnosis is mentioned in literature.
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Affiliation(s)
| | - S. Maes
- Department of Anesthesiology, University Hospital of Antwerp, Edegem, Belgium
| | - D. De Wolf
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - A. Van Berendoncks
- University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
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13
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HAN KN, MA XT, YANG SW, ZHOU YJ. Intracardiac echocardiography in the diagnosis and closure of patent foramen ovale. J Geriatr Cardiol 2021; 18:697-701. [PMID: 34659375 PMCID: PMC8501384 DOI: 10.11909/j.issn.1671-5411.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Kang-Ning HAN
- Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart, Lung and Blood Vessel Disease; The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education; Beijing, China
| | - Xiao-Teng MA
- Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart, Lung and Blood Vessel Disease; The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education; Beijing, China
| | - Shi-Wei YANG
- Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart, Lung and Blood Vessel Disease; The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education; Beijing, China
| | - Yu-Jie ZHOU
- Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart, Lung and Blood Vessel Disease; The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education; Beijing, China
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14
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Otsuki S, Yamakawa T, Ishibashi R, Watari Y, Yokoyama N, Kozuma K. Noncontrast transcatheter pacing system implantation guided by trans-internal jugular vein approach intracardiac echocardiography. HeartRhythm Case Rep 2021; 7:283-285. [PMID: 34026516 PMCID: PMC8134754 DOI: 10.1016/j.hrcr.2021.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Shuji Otsuki
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan.,Department of Cardiology, Sonoda Daiichi Hospital, Tokyo, Japan
| | | | - Ruri Ishibashi
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Yuji Watari
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Naoyuki Yokoyama
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
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15
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Urade T, Verde JM, García Vázquez A, Gunzert K, Pessaux P, Marescaux J, Giménez ME. Fluoroless intravascular ultrasound image-guided liver navigation in porcine models. BMC Gastroenterol 2021; 21:24. [PMID: 33422010 PMCID: PMC7797115 DOI: 10.1186/s12876-021-01600-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background An intravascular ultrasound catheter (IVUSc) was developed for intracardiac ultrasound to assess interventions with compelling results. However, intrahepatic vascular exploration was rarely tested and was always associated with X-ray techniques. The aim of this study was to demonstrate the feasibility to navigate through the whole liver using an IVUSc, providing high-quality images and making it unnecessary to use ionizing radiation.
Methods An ex vivo pig visceral block and an in vivo pig model were used in this study. The IVUS equipment was composed of an US system, and of an 8 French lateral firing IVUSc capable of producing 90-degree sector images in the longitudinal plane. After accessing the intravascular space with the IVUSc into the models, predetermined anatomical landmarks were visualized from the inferior vena cava and hepatic veins and corroborated. Results IVUS navigation was achieved in both models successfully. The entire navigation protocol took 87 and 48 min respectively, and 100% (21/21) and 96.15% (25/26) of the landmarks were correctly identified with the IVUSc alone in the ex vivo and in vivo models respectively. IVUS allowed to clearly visualize the vasculature beyond third-order branches of the hepatic and portal veins. Conclusions A complete IVUS liver navigation is feasible using the IVUSc alone, making it unnecessary to use ionizing radiation. This approach provides high-definition and real-time images of the complex liver structure and offers a great potential for future clinical applications during diagnostic and therapeutic interventions.
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Affiliation(s)
- Takeshi Urade
- Institute of Image-Guided Surgery, IHU Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. .,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.
| | - Juan Manuel Verde
- Institute of Image-Guided Surgery, IHU Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Alain García Vázquez
- Institute of Image-Guided Surgery, IHU Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | | | - Patrick Pessaux
- Institute of Image-Guided Surgery, IHU Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.,Department of General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Institute of Image-Guided Surgery, IHU Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Mariano Eduardo Giménez
- Institute of Image-Guided Surgery, IHU Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
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16
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Comparison of Intracardiac Echocardiography and Transesophageal Echocardiography for Image Guidance in Percutaneous Patent Foramen Ovale Closure. MEDICINA-LITHUANIA 2020; 56:medicina56080401. [PMID: 32784843 PMCID: PMC7466370 DOI: 10.3390/medicina56080401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Transesophageal echocardiography (TEE) guidance is the current gold standard for catheter-based procedures in the treatment of structural heart diseases. Intracardiac echocardiography (ICE), which can be performed under local anesthesia, has been recently introduced and is becoming more widely used. We aimed to compare the efficacy and safety of ICE and TEE in patent foramen ovale (PFO) device closure. Materials and Methods: All 74 patients with a history of cryptogenic stroke undergoing PFO closure for secondary prophylaxis were selected from our registry. Intraprocedural TEE was performed by echocardiographer-cardiologists with the patient under general anesthesia. Conversely, ICE was performed with the patient under local anesthesia. Baseline characteristics, procedural details, and immediate outcomes were compared between the TEE and ICE groups (n = 49 and n = 25, respectively). Results: Although patients in the ICE group were older (47 ± 10 vs. 57 ± 7 years, p < 0.001), sex and comorbidity variables were similar between the two groups. The degree of inducible right-to-left shunt via the PFO, assessed using preprocedural TEE, was also comparable. Notably, fluoroscopy time (22 ± 18 vs. 16 ± 7 min, p = 0.030), radiation dose (498 ± 880 vs. 196 ± 111 mGy, p = 0.022), and total procedural time in the catheter laboratory (99 ± 30 vs. 67 ± 12 min, p < 0.001) were significantly lower in the ICE group than those in the TEE group. The entire hospital stay was similar between groups (3.8 ± 2.2 vs. 3.4 ± 1.3 days, p = 0.433). No procedural complications, such as device embolization, pericardial hemorrhage, major bleeding, mortality, or access-related vascular injury were reported in either group. Conclusions: ICE-guided PFO device closure is quicker and less hazardous in terms of radiation exposure than the TEE-guided procedure, with similar procedural outcomes and duration of hospital stay.
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17
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Intracardiac Echocardiography as a Guide for Transcatheter Closure of Patent Ductus Arteriosus. J Interv Cardiol 2020; 2020:5147193. [PMID: 32802008 PMCID: PMC7414339 DOI: 10.1155/2020/5147193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background Transcatheter closure of patent ductus arteriosus (TC-PDA), conventionally guided by aortography, has become the standard treatment of this disease. The purposes of this study were to evaluate whether intracardiac echocardiography (ICE) may be used for measuring PDA size and be used as a guide for TC-PDA. Methods This study had 2 phases. In phase 1, we compared the measurements of PDA size: pulmonary artery side diameter (PA-D), length, and aortic side diameter (Ao-D) of PDA, as measured by ICE with those measured by aortography or cardiac computed tomography (AoG/CCT) in 23 patients who underwent TC-PDA. In phase 2, we compared the demographics, fluoroscopic time, contrast volume, and complications of the TC-PDAs between 10 adult patients with ICE guidance and 16 without it. Results In phase 1, we found great correlation and agreement between ICE and AoG/CCT in PA-D (r = 0.985, bias −0.077 to 0.224), but moderate to poor correlation and agreement in length (r = 0.653, bias −0.491 to 3.065) and Ao-D (r = 0.704, bias 0.738 to 4.732), respectively. Nevertheless, all patients underwent successful TC-PDA with ICE guidance that allowed us to continuously monitor the whole process. In phase 2, TC-PDA required a significantly lower contrast volume with ICE guidance than without it, and there was no significant difference in the remaining variables between the 2 groups. Conclusion ICE is comparable to AoG/CCT in providing accurate PA-D of the PDA and may be a safe alternative to guide TC-PDA as compared to conventional aortography.
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18
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Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure. Int J Cardiovasc Imaging 2020; 36:855-863. [DOI: 10.1007/s10554-020-01778-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/24/2020] [Indexed: 01/26/2023]
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19
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Enriquez A, Saenz LC, Rosso R, Silvestry FE, Callans D, Marchlinski FE, Garcia F. Use of Intracardiac Echocardiography in Interventional Cardiology: Working With the Anatomy Rather Than Fighting It. Circulation 2019; 137:2278-2294. [PMID: 29784681 DOI: 10.1161/circulationaha.117.031343] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The indications for catheter-based structural and electrophysiological procedures have recently expanded to more complex scenarios, in which an accurate definition of the variable individual cardiac anatomy is key to obtain optimal results. Intracardiac echocardiography (ICE) is a unique imaging modality able to provide high-resolution real-time visualization of cardiac structures, continuous monitoring of catheter location within the heart, and early recognition of procedural complications, such as pericardial effusion or thrombus formation. Additional benefits are excellent patient tolerance, reduction of fluoroscopy time, and lack of need for general anesthesia or a second operator. For these reasons, ICE has largely replaced transesophageal echocardiography as ideal imaging modality for guiding certain procedures, such as atrial septal defect closure and catheter ablation of cardiac arrhythmias, and has an emerging role in others, including mitral valvuloplasty, transcatheter aortic valve replacement, and left atrial appendage closure. In electrophysiology procedures, ICE allows integration of real-time images with electroanatomic maps; it has a role in assessment of arrhythmogenic substrate, and it is particularly useful for mapping structures that are not visualized by fluoroscopy, such as the interatrial or interventricular septum, papillary muscles, and intracavitary muscular ridges. Most recently, a three-dimensional (3D) volumetric ICE system has also been developed, with potential for greater anatomic information and a promising role in structural interventions. In this state-of-the-art review, we provide guidance on how to conduct a comprehensive ICE survey and summarize the main applications of ICE in a variety of structural and electrophysiology procedures.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| | - Luis C Saenz
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia. Instituto de Cardiologia. Centro Internacional de Arritmias "Andrea Natale," Fundacion Cardioinfantil, Bogota, Colombia (L.C.S.)
| | - Raphael Rosso
- Cardiac Eletrophysiology, Cardiology Division, Tel-Aviv Souraski Medical Center, Israel (R.R.)
| | | | - David Callans
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| | | | - Fermin Garcia
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
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Abstract
Purpose of the Review The purpose of this review is to illustrate specific challenges and opportunities in the building of an adult congenital heart disease (ACHD) program and to highlight critical components and important allies. Recent Findings With more than 1.4 million adults with congenital heart disease in the USA alone, access to specialized, compassionate, high-quality comprehensive care requires a shift toward more aggressive expansion of ACHD care, especially in the context of sparse ACHD provider representation in the vast majority of adult medical centers. Summary The effective build of an ACHD program requires measured escalation in management of ACHD complexity matched with cultivation of key resources and clinical services ranging from congenital cardiac surgery and interventional cardiology to acquired heart disease as well as partnerships with non-cardiac specialists. By reframing ACHD care as a shared goal between patients, providers, hospitals, pharmaceutical and device industry, and payers, a potent business model can be built around the developing ACHD program to facilitate acquisition of these key resources.
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21
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Rigatelli G, Zuin M, Nghia NT. Interatrial shunts: technical approaches to percutaneous closure. Expert Rev Med Devices 2018; 15:707-716. [DOI: 10.1080/17434440.2018.1526674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gianluca Rigatelli
- Section of Congenital and Structural Heart Disease Interventions, Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Nguyen Tuong Nghia
- Department of Interventional cardiology, Cho-Ray Hospital, Ho Chi minh City, Vietnam
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22
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Collado FMS, Poulin MF, Murphy JJ, Jneid H, Kavinsky CJ. Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders. J Am Heart Assoc 2018; 7:e007146. [PMID: 29910192 PMCID: PMC6220531 DOI: 10.1161/jaha.117.007146] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Fareed Moses S Collado
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Marie-France Poulin
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Joshua J Murphy
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Clifford J Kavinsky
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
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Fayad A, Shillcutt SK. Perioperative transesophageal echocardiography for non-cardiac surgery. Can J Anaesth 2018; 65:381-398. [PMID: 29150779 PMCID: PMC6071868 DOI: 10.1007/s12630-017-1017-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The use of transesophageal echocardiography (TEE) has evolved to include patients undergoing high-risk non-cardiac procedures and patients with significant cardiac disease undergoing non-cardiac surgery. Implementation of basic TEE education in training programs has increased across a broad spectrum of procedures in the perioperative arena. This paper describes the use of perioperative TEE in non-cardiac surgery and provides an overview of the basic TEE examination. PRINCIPAL FINDINGS Perioperative TEE is used to monitor hemodynamic parameters in non-cardiac procedures where there is a high risk of hemodynamic instability. Its use extends to include moderate-risk procedures for patients with significant cardiac diseases such as low ejection fraction, hypertrophic cardiomyopathy, severe valve lesions, or congenital heart disease. Vascular procedures involving the aorta, blunt trauma, and liver transplantation are all examples of procedures that may benefit from TEE. Transesophageal echocardiography examination allows assessment of volume status, ventricular function, diagnosis of gross valvular pathology and pericardial tamponade, as well as close monitoring of cardiac output, response to therapy, and the impact of ongoing surgical manipulation. In patients with unexplained and unexpected hemodynamic instability, "rescue TEE" can be used to help identify the underlying cause. CONCLUSIONS Perioperative TEE is emerging as a preferred tool to manage hemodynamics in high-risk procedures and in high-risk patients undergoing non-cardiac surgery. A rescue TEE examination protocol is a helpful approach for early identification of the etiology of hemodynamic instability.
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Affiliation(s)
- Ashraf Fayad
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Sasha K Shillcutt
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
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Echocardiographic Imaging for Left Atrial Appendage Occlusion: Transesophageal Echocardiography and Intracardiac Echocardiographic Imaging. Interv Cardiol Clin 2018. [PMID: 29526290 DOI: 10.1016/j.iccl.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Left atrial appendage occlusion (LAAO) is a rapidly evolving technology. Multi-modality imaging and understanding of left atrial appendage anatomy are sure to advance. Two-dimensional and 3-dimensional transesophageal echocardiography with fluoroscopy are the mainstay for LAAO image-guided therapy. Key to successful LAAO is an understanding of the transseptal puncture, LAAO size selection for the device-specific landing zone, and postdeployment evaluation for leak and complications. With advancements in computed tomography, there may be a greater role for intracardiac echocardiographic imaging in specific types of LAAO anatomy and devices.
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Scacciatella P, Meynet I, Giorgi M, Biava LM, Matranga I, Biasco L, Omedè P, Orzan F, Gaita F. Angiography vs transesophageal echocardiography-guided patent foramen ovale closure: A propensity score matched analysis of a two-center registry. Echocardiography 2018; 35:834-840. [PMID: 29457261 DOI: 10.1111/echo.13842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The purpose of this study is to compare the long-term outcomes of patent foramen ovale (PFO) closure using angiography or transesophageal echocardiography as procedural guidance. BACKGROUND The interventional treatment is emerging as a safe and efficient option for patients with high likelihood of PFO-related cryptogenic stroke and high risk of recurrence. The "gold-standard" guidance technique remains an issue. METHODS Two cohorts of patients undergoing PFO closure for cryptogenic stroke in two catheterization laboratories of the same institution, using similar inclusion criteria but different guidance, were compared with propensity score matching. RESULTS A total of 374 patients were enrolled, 161 in Angio-group and 213 in Echo-group. No difference was detected in the procedural complication rate. In Angio-group, radiological exposure (P = .001) and 6-month residual shunt (16.8% vs 8.0%, P = .015) were higher. After a mean follow-up of 41 ± 30 months, 28 patients (7.5%) presented any adverse event (death, recurrent cerebral ischemia, device-related complications, reintervention), with a higher rate in Angio-group (13.0% vs 3.3%, P = .001), mainly due to repeated percutaneous intervention (10.6% vs 1.4%, P = .001). The results were confirmed after propensity score matching (118 patients/group). The rate of recurrent cerebral ischemia was 1.9% and was not significantly different in the two groups. Intra-procedural guidance and atrial septum aneurysm were independent predictors of the composite primary endpoint (OR 1.2, P = .016). CONCLUSIONS The use of intra-procedural transesophageal echocardiography (TEE) guidance for PFO closure allows lower residual shunt rate, radiological exposure, and adverse events, mainly driven by a significant reduction in percutaneous reintervention.
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Affiliation(s)
- Paolo Scacciatella
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ilaria Meynet
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mauro Giorgi
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lorenza M Biava
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ivana Matranga
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luigi Biasco
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pierluigi Omedè
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fulvio Orzan
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fiorenzo Gaita
- Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
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Kavvouras C, Vavuranakis M, Vaina S, Lampropoulos K, Bazoukis G, Tse G, Tousoulis D. Intracardiac echocardiography for percutaneous patent foramen ovale and atrial septal defect occlusion. Herz 2018; 44:445-449. [DOI: 10.1007/s00059-017-4678-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/19/2017] [Accepted: 12/29/2017] [Indexed: 12/27/2022]
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Basman C, Parmar YJ, Kronzon I. Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions. Curr Cardiol Rep 2017; 19:102. [PMID: 28879526 DOI: 10.1007/s11886-017-0902-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions. RECENT FINDINGS 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.
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Affiliation(s)
- Craig Basman
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA
| | - Yuvrajsinh J Parmar
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA
| | - Itzhak Kronzon
- Department of Cardiovascular Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, USA.
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Aguirre D, Pincetti C, Perez L, Deck C, Alfaro M, Vergara MJ, Maluenda G. Single trans-septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure. Catheter Cardiovasc Interv 2017; 91:356-361. [DOI: 10.1002/ccd.27246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 07/16/2017] [Accepted: 07/22/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Daniel Aguirre
- San Borja Arriaran Hospital and University of Chile, Santiago, Región Metropolitana, Chile
- Clinica Alemana de Santiago, Vitacura, Región Metropolitana, Chile
| | | | - Luis Perez
- Guillermo Grant Benavente Hospital, VIII Region; Chile
| | - Carlos Deck
- Dipreca Hospital, Región Metropolitana, Chile
| | - Mario Alfaro
- San Borja Arriaran Hospital and University of Chile, Santiago, Región Metropolitana, Chile
| | - Maria Jesus Vergara
- San Borja Arriaran Hospital and University of Chile, Santiago, Región Metropolitana, Chile
| | - Gabriel Maluenda
- San Borja Arriaran Hospital and University of Chile, Santiago, Región Metropolitana, Chile
- Clinica Alemana de Santiago, Vitacura, Región Metropolitana, Chile
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Matsuo Y, Neuzil P, Petru J, Chovanec M, Janotka M, Choudry S, Skoda J, Sediva L, Kurabayashi M, Reddy VY. Left Atrial Appendage Closure Under Intracardiac Echocardiographic Guidance: Feasibility and Comparison With Transesophageal Echocardiography. J Am Heart Assoc 2016; 5:JAHA.116.003695. [PMID: 27680664 PMCID: PMC5121476 DOI: 10.1161/jaha.116.003695] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Transcatheter left atrial appendage closure is an alternative therapy for stroke prevention in atrial fibrillation patients. These procedures are currently guided with transesophageal echocardiography and fluoroscopy in most centers. As intracardiac echocardiography (ICE) is commonly used in other catheter‐based procedures, we sought to determine the safety and effectiveness of intracardiac echocardiography–guided left atrial appendage closure with the Watchman device. Methods and Results A total of 27 patients (11 males, 77.0±8.5 years) with atrial fibrillation receiving Watchman left atrial appendage closure under intracardiac echocardiography guidance at a single center were investigated. All patients were implanted successfully. There were no major procedural complications. The overall procedure‐related complication rate was 14.8%, mainly due to access site hematoma. Transesophageal echocardiography demonstrated successful closure of the left atrial appendage in all patients at 45 days after device implant. Conclusions Transcatheter left atrial appendage closure with intracardiac echocardiography guidance is safe and feasible.
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Affiliation(s)
- Yae Matsuo
- Department of Cardiology, Nemocnice Na Homolce-Homolka Hospital, Prague, Czech Republic Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Petr Neuzil
- Department of Cardiology, Nemocnice Na Homolce-Homolka Hospital, Prague, Czech Republic
| | - Jan Petru
- Department of Cardiology, Nemocnice Na Homolce-Homolka Hospital, Prague, Czech Republic
| | - Milan Chovanec
- Department of Cardiology, Nemocnice Na Homolce-Homolka Hospital, Prague, Czech Republic
| | - Marek Janotka
- Department of Cardiology, Nemocnice Na Homolce-Homolka Hospital, Prague, Czech Republic
| | - Subbarao Choudry
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jan Skoda
- Department of Cardiology, Nemocnice Na Homolce-Homolka Hospital, Prague, Czech Republic
| | - Lucie Sediva
- Department of Cardiology, Nemocnice Na Homolce-Homolka Hospital, Prague, Czech Republic
| | - Masahiko Kurabayashi
- Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Vivek Y Reddy
- Department of Cardiology, Nemocnice Na Homolce-Homolka Hospital, Prague, Czech Republic Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Tobis JM, Abudayyeh I. Platypnea-Orthodeoxia Syndrome. JACC Cardiovasc Interv 2016; 9:1939-40. [DOI: 10.1016/j.jcin.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
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31
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Anatomy of the true interatrial septum for transseptal access to the left atrium. Ann Anat 2016; 205:60-4. [DOI: 10.1016/j.aanat.2016.01.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 11/17/2022]
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Teramachi Y, Suda K, Yoshimoto H, Kishimoto S, Kudo Y, Iemura M. Transpulmonary echocardiography to guide stent implantation into coarctation of the aorta. Echocardiography 2016; 32:872-4. [PMID: 25903698 DOI: 10.1111/echo.12896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although stent implantation into aortic coarctation has been performed solely under fluoroscopy, we successfully applied intracardiac echocardiography (ICE) to guide this procedure in a 13-year-old patient. Placing an intracardiac echocardiographic catheter in the left pulmonary artery facing upward, we readily visualized the precise anatomy of coarctation, measured the pressure gradient, and monitored the stent inflation process. This report suggests a new application of ICE for intervention with structural and vascular diseases other than interatrial septum.
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Affiliation(s)
- Yozo Teramachi
- Department of Pediatric Cardiology, St. Mary's Hospital, Kurume, Japan
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The Utility of Intracardiac Echocardiography Following Melody™ Transcatheter Pulmonary Valve Implantation. Pediatr Cardiol 2015; 36:1754-60. [PMID: 26169526 DOI: 10.1007/s00246-015-1230-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/03/2015] [Indexed: 02/07/2023]
Abstract
The aim of this study was to determine the utility of intracardiac echocardiography (ICE) in assessing Melody™ transcatheter pulmonary valve (TPV) function immediately following valve implantation. ICE is used increasingly in percutaneous cardiac interventions. At our center, ICE is routinely utilized to evaluate valve function following Melody TPV implantation, but the utility of this practice remains unclear. A retrospective review of all Melody valves placed in the right ventricular outflow tract from April 2010 to September 2013 was performed. The clinical utility of ICE was described, along with the relationship between ICE data and traditional hemodynamic/angiographic data. ICE was performed in 54 cases and provided excellent Melody TPV visualization with no complications. ICE did not change clinical management but did provide supplemental information in two cases. In one case, angiography showed severe catheter-related Melody insufficiency. Subsequent ICE confirmed no insufficiency and prevented the need for additional angiography. In the second case, ICE allowed characterization of the mechanism of a residual gradient. ICE did not detect any clinically significant paravalvar leaks or valvar insufficiency not seen by angiography. The peak catheterization gradient was more closely approximated by the mean ICE gradient (median difference -7.4 % between measurements) than by the peak ICE gradient (median difference 58.3 %; p < 0.0001). ICE provides excellent and safe visualization following Melody TPV implantation but did not provide new clinical information impacting management in this series. Selective use of ICE in cases with more than expected valve insufficiency or larger than expected residual gradients may streamline use while maintaining optimal clinical outcomes.
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Kudo Y, Suda K, Yoshimoto H, Teramachi Y, Kishimoto S, Iemura M, Matsuishi T. Trans-pulmonary echocardiography as a guide for device closure of patent ductus arteriosus. Catheter Cardiovasc Interv 2015; 86:264-70. [PMID: 25676054 DOI: 10.1002/ccd.25879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/31/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of this study was to develop trans-pulmonary echocardiography (TPE) to guide device closure of patent ductus arteriosus (DC-PDA). BACKGROUND Aortography requires a large amount of contrast yet may give us an inadequate image to evaluate anatomy or residual shunt in patients with large PDA or dilated vessels and is precluded in patients with renal dysfunction. Practically, there is no imaging modality to monitor the entire procedure except for trans-esophageal echocardiography that requires general anesthesia. METHODS Subjects were seven patients with ages ranged from 6- to 77-years old and body weight > 15 kg. The size of the PDA ranged from 1.8 to 6.3 mm with pulmonary to systemic flow ratios from 1.2 to 2.2. During DC-PDA using Ampaltzer Duct Occluder or coil, an intra-cardiac echocardiographic (ICE) catheter was advanced into pulmonary arteries and standard views were developed to guide DC-PDA. RESULTS We have developed two standard views; the main pulmonary artery view (MPA view) and the left pulmonary artery view (LPA view). The MPA view provided aortic short axis view equivalent to that seen by trans-thoracic echocardiography in children. The LPA view, obtained by the echo probe in the LPA and turned it up upside down, provided long axis view of the PDA allowing more precise anatomical evaluation. TPE allowed us to monitor the entire procedure and determine residual shunts. CONCLUSIONS TPE in the MPA and LPA view can be an effective guide for DC-PDA. This report leads to new application of this imaging device.
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Affiliation(s)
- Yoshiyuki Kudo
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Kenji Suda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Hironaga Yoshimoto
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Yozo Teramachi
- Department of Pediatric Cardiology, St. Mary's Hospital, Kurume, Japan
| | - Shintaro Kishimoto
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Motofumi Iemura
- Department of Pediatric Cardiology, St. Mary's Hospital, Kurume, Japan
| | - Toyojiro Matsuishi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
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Rao PS. Is Intracardiac Echocardiography Essential for Monitoring Stent Deployment across Aortic Coarctation? Echocardiography 2015; 32:731-3. [PMID: 25684662 DOI: 10.1111/echo.12905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- P Syamasundar Rao
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Texas-Houston Medical School/Children's Memorial Hermann Hospital, Houston, Texas
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36
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Yoshimoto H, Suda K, Kishimoto S, Kudo Y. Intra-cardiac echocardiography-guided stent implantation into stenosed superior vena cava in a patient with a history of contrast anaphylaxis. Heart Vessels 2015; 31:631-4. [PMID: 25605657 DOI: 10.1007/s00380-015-0631-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/09/2015] [Indexed: 11/26/2022]
Abstract
A 37-year-old patient, who suffered from a repeated superior vena cava (SVC) syndrome, was scheduled for stent implantation into SVC, but suffered from contrast anaphylaxis. To monitor the procedure, we used intra-cardiac echocardiography and successfully implanted a stent. Placing an intra-cardiac echocardiographic catheter in the main pulmonary artery and facing towards the right, we could readily visualize stenosis in the SVC and inflation of the stent. Also looking up from right atrium, we noted proximal obstruction of the stent and confirmed the relief of obstruction after additional balloon dilation. This report leads to new application of intra-cardiac echocardiography for intervention of structural and vascular diseases other than inter-atrial septum.
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Affiliation(s)
- Hironaga Yoshimoto
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-Machi 67, Kurume, 830-0011, Japan
| | - Kenji Suda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-Machi 67, Kurume, 830-0011, Japan.
| | - Shintaro Kishimoto
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-Machi 67, Kurume, 830-0011, Japan
| | - Yoshiyuki Kudo
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Asahi-Machi 67, Kurume, 830-0011, Japan
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Awad SM, Masood SA, Gonzalez I, Cao QL, Abdulla RI, Heitschmidt MG, Hijazi ZM. The use of intracardiac echocardiography during percutaneous pulmonary valve replacement. Pediatr Cardiol 2015; 36:76-83. [PMID: 25070389 DOI: 10.1007/s00246-014-0967-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/11/2014] [Indexed: 11/30/2022]
Abstract
High-quality live imaging assessment of cardiac valves and cardiac anatomy is crucial for the success of catheter-based procedures. We present our experience using Intracardiac echocardiography (ICE) during transcatheter Percutaneous Pulmonary Valve replacement (tPVR).This is a retrospective study that included 35 patients who underwent tPVR between April 2008 and June 2012. Thirty-one of these patients had the procedure performed under continuous ICE guidance. Pre-procedure transthoracic echocardiography (TTE) was obtained in all patients. ICE was performed at baseline, during the procedure, and at the conclusion of the procedure. Comparisons between the pre-procedure TTE and baseline ICE data and between post-procedure ICE data and the following day TTE were performed. Total of 35 patients had tPVR during the above-mentioned time period. Twenty-one patients received the Edwards Sapien valve and 14 patients had the Melody valve. Thirty-one patients had the procedure performed under continuous ICE guidance. The mean Pre-TTE peak gradient (PG) and Pre-ICE-PG were 45.5 ± 20 vs 33 ± 13 mmHg (p < 0.001) and the mean Pre-TTE mean gradient (MG) and Pre-ICE-MG were 27.7 ± 13 vs 21 ± 18 mmHg (p < 0.001). The mean Post-TTE- PG and Post-ICE-PG were 24.3 ± 11 vs 15.3 ± 7 mmHg (p < 0.001) and the mean of the Post-TTE-MG and Post-ICE-MG were 14.2 ± 7 vs 8.4 ± 4 mmHg (p < 0.001). There was a good correlation between peak ICE and TTE gradient at baseline and after valve placement. For the degree of pulmonary regurgitation, there was no significant difference between TTE and ICE. ICE is an important modality to guide tPVR in patients with dysfunctional homograft valve between the right ventricle and pulmonary artery and should be used to assess valve function before, during and immediately after the procedure.
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Affiliation(s)
- Sawsan M Awad
- Rush Centre for Congenital and Structural Heart Disease, Rush University Medical Centre, Chicago, IL, 60612, USA,
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Rigatelli G, Dell'Avvocata F, Giordan M, Viceconte N, Osanna RA, Braggion G, Aggio S, Cardaioli P, Chen JP. Usefulness of intracardiac echocardiography with a mechanical probe for catheter-based interventions: a 10-year prospective registry. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:534-543. [PMID: 24898198 DOI: 10.1002/jcu.22177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/04/2014] [Accepted: 05/06/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The clinical outcome benefit of intracardiac echocardiography (ICE) with a mechanical probe during congenital heart disease interventions has not been fully investigated. We reported the long-term results of a prospective registry of interatrial shunt closure guided by mechanical ICE. METHODS We enrolled 537 patients (mean age 48 ± 19.0 years, 378 females) submitted to ICE-aided procedures in a prospective registry over a 10-year period (September 2003-September 2013). All patients underwent transesophageal echocardiography (TEE) before the planned procedure. We evaluated (1) structure identification capability, (2) fossa ovale and interatrial septum component measurement, (3) procedure monitoring capability, (4) procedural and fluoroscopy times, and radiograph dose, (5) probe-related complications. RESULTS ICE was successfully performed and was able to correctly identify the structures previously assessed by TEE in all patients. In 24 patients (4.5%), ICE allowed better anatomy definition than TEE. In 35 other patients (6.5%), ICE identified structures not observed by TEE, which led to change indications to interventions or the operative technique to be used. In 131 patients (24.4%), ICE evaluation led to change the planned device to be implanted. There was only one probe-related complication (0.2%). CONCLUSIONS Mechanical ICE may offer a valid alternative to conventional TEE in guiding congenital heart disease interventional procedures.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
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Assaidi A, Sumian M, Mauri L, Mancini J, Ovaert C, Salaun E, Habib G, Fraisse A. Transcatheter closure of complex atrial septal defects is efficient under intracardiac echocardiographic guidance. Arch Cardiovasc Dis 2014; 107:646-53. [PMID: 25241222 DOI: 10.1016/j.acvd.2014.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/25/2014] [Accepted: 06/24/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Studies on intracardiac echocardiography for transcatheter closure of secundum atrial septal defect (ASD) only include ASDs ≤38mm diameter without rim deficiency. AIMS To assess transcatheter closure of complex ASDs under intracardiac echocardiography guidance. METHODS Retrospective study from January 2006 to January 2012 in all consecutive adult patients referred to our centre for percutaneous device closure of ASD. Complex cases were defined as defect>38mm and/or defect with rim deficiency other than the anterior-superior rim. RESULTS Transcatheter closure was performed in 93 consecutive adult patients (59 women) with a median age of 48 (18-88) years. Complex cases comprised 17 patients (18%) with a median age of 54 (20-81) years and a median weight of 58 (45-99) kg. Thirteen cases had one or more deficient rims other than the anterior-superior rim, whereas nine had an ASD size>38mm. Transcatheter closure was successful in 14 cases, whereas three cases failed (18%). Minor complications occurred in three patients (18%). All the other non-complex ASDs were successfully closed percutaneously. Among the 93 patients, rim deficiency other than the anterior-superior rim tended to be associated with failure of transcatheter closure (P=0.058). CONCLUSION Transcatheter closure of complex ASDs is safe and effective under intracardiac echocardiographic guidance.
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Affiliation(s)
- Anass Assaidi
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Marion Sumian
- Service de cardiologie B, hôpital de la Timone-Adultes, Marseille, France
| | - Lucia Mauri
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Julien Mancini
- Biostatistiques et technologies de l'information et de la communication (BiosTIC), hôpital de la Timone, Aix Marseille Université, Inserm, IRD, UMR_S912, SESSTIM, Marseille, France
| | - Caroline Ovaert
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Erwann Salaun
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Gilbert Habib
- Service de cardiologie B, hôpital de la Timone-Adultes, Marseille, France
| | - Alain Fraisse
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France.
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Hijazi ZM, Suradi H. Intracardiac Echocardiography-Guided Interventions. JACC Cardiovasc Interv 2014; 7:1045-7. [DOI: 10.1016/j.jcin.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
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Medford BA, Taggart NW, Cabalka AK, Cetta F, Reeder GS, Hagler DJ, Johnson JN. Intracardiac echocardiography during atrial septal defect and patent foramen ovale device closure in pediatric and adolescent patients. J Am Soc Echocardiogr 2014; 27:984-90. [PMID: 24998516 DOI: 10.1016/j.echo.2014.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is commonly used during interventional cardiac catheterization in adults, but data regarding the use of ICE in children are limited. There are no data available comparing the effectiveness of preprocedural transthoracic echocardiography (TTE) with that of intraprocedural ICE in predicting atrial septal defect (ASD) size and rim adequacy for percutaneous closure in a pediatric population. The objectives of this study were to describe the investigators' experience using ICE in pediatric and adolescent patients and to compare the effectiveness of preprocedural TTE with that of ICE in predicting ASD size and rim adequacy for percutaneous closure. METHODS In this retrospective study, all cases in which ICE was used during ASD or patent foramen ovale closure in patients ≤21 years of age at a single institution from January 2002 through October 2013 were reviewed. All studies were performed using the Acuson AcuNav ICE system. RESULTS One hundred fifteen patients (65 female; mean age, 12 ± 6 years; range, 10 months to 21 years) were included. All intracardiac echocardiographic studies were performed by the interventional cardiologist performing the catheterization. ICE was used to facilitate ASD closure in 92 patients (81%) and patent foramen ovale closure in 23 (19%). Thirty-eight patients (34%) underwent cardiac catheterization and ICE without general anesthesia. ICE was correlated highly with preprocedural TTE in predicting ASD size (r(2) = 0.76, P < .0001). In nine of 92 patients (9.8%) with ASDs, ICE identified deficient septal rims (n = 8) or complex or multiple ASDs (n = 1) that necessitated surgical closure. There were no major complications. CONCLUSIONS ICE can be performed safely and effectively in a large cohort of children and adolescents undergoing percutaneous device closure. ICE may obviate the need for general anesthesia in some patients and is a reasonable alternative to transesophageal echocardiography for this catheter-based procedure in children. ASD measurements with ICE correlate well with preprocedural measurements on TTE; however, ICE more accurately identifies the absence or deficiency of critical septal rims before device closure.
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Affiliation(s)
- Beth A Medford
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
| | - Nathaniel W Taggart
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Allison K Cabalka
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Frank Cetta
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Donald J Hagler
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
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George JC, Varghese V, Mogtader A. Intracardiac echocardiography: evolving use in interventional cardiology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:387-395. [PMID: 24567449 DOI: 10.7863/ultra.33.3.387] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intracardiac echocardiography (ICE) uses a catheter-based steerable ultrasound probe that is passed into the right heart chambers to image intracardiac structures. The transducer can be variably positioned for optimal imaging: in the inferior vena cava to visualize the abdominal aorta; in the right atrium for the interatrial septum, aortic, mitral, and tricuspid valves, and pulmonary veins; or in the right ventricle for the left ventricular function, outflow tract, or pulmonary artery. Intracardiac echocardiography is primarily used for imaging during an invasive cardiac procedure using conscious sedation, when transthoracic image quality would likely be inadequate, and transesophageal imaging would require general anesthesia. Intracardiac echocardiography is generally well tolerated and provides adequate images and sufficient information for the procedure performed. In the cardiac catheterization laboratory, ICE is routinely used for patent foramen ovale, atrial septal defect, and ventricular septal defect closures, allowing adequate percutaneous placement of septal occluders. It is now being considered in the current era of transcatheter aortic valve implantation necessitating improved imaging approaches for accurate placement. It is also routinely used for trans-septal punctures during mitral valvuloplasty and, more recently, with the advent of left atrial appendage closure devices. This article provides a comprehensive review of the current technology for ICE and its growing applications in the realm of interventional cardiology.
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Affiliation(s)
- Jon C George
- Cardiac Catheterization Laboratory, Deborah Heart and Lung Center, 200 Trenton Rd, Browns Mills, NJ 08015 USA.
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Rigatelli G, Cardaioli P, Hijazi ZM. Contemporary clinical management of atrial septal defects in the adult. Expert Rev Cardiovasc Ther 2014; 5:1135-46. [DOI: 10.1586/14779072.5.6.1135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Intracardiac echocardiography for percutaneous closure of atrial septal defects: initial experiences in Japan. Cardiovasc Interv Ther 2013; 28:368-73. [DOI: 10.1007/s12928-013-0187-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 05/15/2013] [Indexed: 11/25/2022]
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Tanaka J, Izumo M, Fukuoka Y, Saitoh T, Harada K, Harada K, Gurudevan SV, Tolstrup K, Siegel RJ, Shiota T. Comparison of two-dimensional versus real-time three-dimensional transesophageal echocardiography for evaluation of patent foramen ovale morphology. Am J Cardiol 2013; 111:1052-6. [PMID: 23352264 DOI: 10.1016/j.amjcard.2012.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
The aim of this study was to elucidate patent foramen ovale (PFO) morphology and the change of PFO size using real-time 3-dimensional (3D) transesophageal echocardiography (TEE). PFO is a 3D structure, and its shape changes during the cardiac cycle. Therefore, it may be difficult to estimate accurate PFO morphology using 2-dimensional (2D) TEE. The study included 50 patients with PFO who underwent 2D and 3D TEE. PFO heights (PHs) at entrance, mid, and exit were measured by 2D and 3D TEE. Systolic and diastolic areas were also measured by 3D TEE. PH by 3D TEE was larger than that by 2D TEE (entrance 0.32 ± 0.18 vs 0.21 ± 0.15 cm, p <0.001; mid 0.25 ± 0.14 vs 0.15 ± 0.11 cm, p <0.001; exit 0.19 ± 0.11 vs 0.11 ± 0.08 cm, p <0.001). Systolic area was greater than diastolic area at each location (entrance 0.19 ± 0.17 vs 0.11 ± 0.11 cm(2), p = 0.001; mid 0.13 ± 0.11 vs 0.08 ± 0.06 cm(2), p = 0.001; exit 0.09 ± 0.09 vs 0.06 ± 0.05 cm(2), p = 0.01). Additionally, entrance area was greater than exit area in systole and diastole (systole 0.19 ± 0.17 vs 0.09 ± 0.09 cm(2), p <0.001; diastole 0.11 ± 0.11 vs 0.06 ± 0.05 cm(2), p = 0.001). There were good correlations between PH by 3D TEE and PFO area (entrance r = 0.68, mid r = 0.71, exit r = 0.78) but weak correlations between PH by 2D TEE and PFO area (entrance r = 0.62, mid r = 0.50, exit r = 0.51). In conclusion, real-time 3D TEE could provide detailed and unique information on PFO morphology.
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Bhaya M, Mutluer FO, Mahan E, Mahan L, Hsiung MC, Yin WH, Wei J, Tsai SK, Zhao GY, Yin WH, Pradhan M, Beniwal R, Joshi D, Nabavizadeh F, Singh A, Nanda NC. Live/Real Time Three-Dimensional Transesophageal Echocardiography in Percutaneous Closure of Atrial Septal Defects. Echocardiography 2013; 30:345-53. [DOI: 10.1111/echo.12106] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Maneesha Bhaya
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Ferit Onur Mutluer
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Edward Mahan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Luke Mahan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Ming C. Hsiung
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Wei-Hsian Yin
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Jeng Wei
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Shen-Kou Tsai
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Guang-Yu Zhao
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Wei-Hsian Yin
- Faculty of Medicine; National Yang-Ming University; Taipei; Taiwan
| | - Manish Pradhan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | | | - Deepak Joshi
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Fatemeh Nabavizadeh
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Amitoj Singh
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Navin C. Nanda
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
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Li GS, Li HD, Yang J, Zhang WQ, Hou ZS, Li QC, Zhang Y. Feasibility and safety of transthoracic echocardiography-guided transcatheter closure of atrial septal defects with deficient superior-anterior rims. PLoS One 2012; 7:e51117. [PMID: 23284660 PMCID: PMC3524244 DOI: 10.1371/journal.pone.0051117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/29/2012] [Indexed: 11/26/2022] Open
Abstract
Although previous studies showed that transthoracic echocardiography (TTE) can be used to guide transcatheter closure of atrial septal defect (ASD), whether TTE can be used to guide transcatheter closure of secundum ASD with a deficient superior-anterior rim is unknown and this critical issue was addressed in the present study. A total of 280 patients with secundum ASD who underwent transcatheter ASD closure were recruited and divided into groups A and B depending on ASD superior-anterior rim>4 mm (n = 118) or ≤4 mm (n = 162). TTE was used to guide Amplatzer-type septal occluder (ASO) positioning and assess residual shunt. Procedure success was defined as no, trivial and small residual shunt immediately after the procedure as assessed by color Doppler flow imaging. Group A and group B did not differ in complication rate (8.55% vs.7.55%), procedure success rate (98.3% vs. 95.0%) or complete closure rate immediately after the procedure (89.7% vs. 89.3%) or at 6-month follow-up (98.3% vs. 96.8%). The mean procedure and fluoroscopy time in group B were much longer than those in group A. In conclusion, the absence of a sufficient superior-anterior rim in patients undergoing percutaneous closure of secundum-type ASDs using fluoroscopic and TTE guidance is associated with slightly greater device malposition and migration as well as increased procedural and fluoroscopic times, but the overall complication rate did not differ with TTE guidance when compared to historical controls that used TEE guidance.
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Affiliation(s)
- Gui-Shuang Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital Shandong University, Jinan, Shandong, China
| | - Hai-De Li
- Yishui People's Hospital, Yishui, Shandong, China
| | - Jie Yang
- Department of Pediatrics, Qilu Hospital Shandong University, Jinan, Shandong, China
| | | | - Zong-Shen Hou
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital Shandong University, Jinan, Shandong, China
| | - Qing-Chen Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital Shandong University, Jinan, Shandong, China
| | - Yun Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Qilu Hospital Shandong University, Jinan, Shandong, China
- * E-mail:
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Abstract
Patent foramen ovale (PFO) is considered a risk factor for serious clinical syndromes, the most important of which is cryptogenic stroke in the setting of paradoxic embolism. The safety and feasibility of transcatheter PFO closure have been addressed in several studies; this procedure is performed worldwide with excellent results. Variations in the atrial septal configuration and PFO are frequent and have an impact on the technical aspects and success in transcatheter PFO closure. To minimize the rate of complications of percutaneous closure of PFO, patients must be carefully selected on the basis of morphology and location of the interatrial defect.
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Affiliation(s)
- Eustaquio Onorato
- Clinica Montevergine, Via M. Malzoni, 83013 Mercogliano (Av), Italy; Humanitas Gavazzeni, Bergamo, Italy.
| | - Francesco Casilli
- Emodinamica e Radiologia Cardiovascolare, Policlinico San Donato, Piazza Edmondo Malan-20097 San Donato Milanese, Milano, Italy
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RIGATELLI GIANLUCA, DELL'AVVOCATA FABIO, CARDAIOLI PAOLO, GIORDAN MASSIMO, DUNG HOTHUONG, NGHIA NGUYENTHUONG, DAGGUBATI RAMESH, NANJIUNDAPPA ARAVINDA. Safety and Long-Term Outcome of Modified Intracardiac Echocardiography-Assisted “No-Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect. J Interv Cardiol 2012; 25:628-34. [DOI: 10.1111/j.1540-8183.2012.00755.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kliger C, Cruz-Gonzalez I, Ruiz CE. The present and future of intracardiac echocardiography for guiding structural heart disease interventions. Rev Esp Cardiol 2012; 65:791-4. [PMID: 22695076 DOI: 10.1016/j.recesp.2012.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 03/08/2012] [Indexed: 11/26/2022]
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