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Papadopoulos CH, Kadoglou NPE, Theodosis-Georgilas A, Karabinos I, Loizos S, Papadopoulos KG, Chrysoheris M, Ninios V, Frogoudaki A, Drakopoulou M, Angelaki M, Rallidis L, Kassinos N, Sahpekidis V, Makavos G, Yiangou K, Karagiannis S, Zois N, Patrianakos A, Ikonomidis I, Tsiapras D, Kouris N, Aggeli K, Pappas K, Prappa E, Stefanidis A. Transoesophageal echocardiography beyond the Echo-Laboratory. An expert consensus paper of the working group of echocardiography of the Hellenic Society of Cardiology. Hellenic J Cardiol 2024:S1109-9666(24)00128-3. [PMID: 38901557 DOI: 10.1016/j.hjc.2024.06.004] [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: 03/24/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
Transoesophageal echocardiography (TOE) is a well-established and valid imaging modality, providing more accurate and of higher quality information than transthoracic echocardiography (TTE) for several specific diagnoses and recently a useful guide of an increasing number of catheter-based and surgical interventions. The present paper represents an effort by the Echocardiography Working Group (WG) of the Hellenic Society of Cardiology to state the essential steps of the TOE exam performed beyond the echo lab: a) in the operating rooms intraoperatively during either transcatheter interventions, or cardiothoracic surgery and b) in the intensive care unit for critically ill patients' monitoring. This paper includes information and tips and tricks about the pre-procedural evaluation, the procedural echocardiographic guidance and post - procedural evaluation of the result and potential complications.
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Affiliation(s)
| | | | | | | | | | | | | | - Vlasis Ninios
- 2(nd) Cardiology Department, Interbalkan Center, Thessaloniki, Greece
| | | | - Maria Drakopoulou
- 1(st) Cardiology Department, Hippokration University Hospital, Athens, Greece
| | - Maria Angelaki
- 1(nd) Cardiology Department, Korgialenio - Benakio Red Cross Hospital, Athens, Greece
| | - Loukianos Rallidis
- 2(nd) Cardiology Department, Attikon University Hospital, Athens, Greece
| | | | | | | | | | | | - Nikolaos Zois
- Private practice, Cardiology Department, University Hospital of Ioannina, Greece
| | | | | | - Dimitrios Tsiapras
- 2nd Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | | | - Konstantina Aggeli
- 1(st) Cardiology Department, Hippokration University Hospital, Athens, Greece
| | | | - Efstathia Prappa
- Cardiology Department, General Hospital of Evaggelismos, Athens, Greece
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Lucarelli K, Acquaviva T, Ferrero P, De Cillis E, Casamassima V, Basile E, Cacciapaglia E, Iorio E, Martimucci M, Cecere G, Petti P, Caruso R, Langialonga T, Bortone A, Grimaldi M, Chessa M. Transcatheter closure of atrial septal defect using intracardiac echocardiography: a two-center, retrospective study. J Cardiovasc Med (Hagerstown) 2024; 25:311-317. [PMID: 38488065 DOI: 10.2459/jcm.0000000000001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
AIMS We present the experience and long-term results of intracardiac echocardiography (ICE)-guided closure of ostium secundum atrial septal defects (ASDs) in two Italian centers and investigate its systematic applicability as the gold standard in routine clinical practice. METHODS We retrospectively evaluated all consecutive patients who underwent an ASD percutaneous closure procedure from March 2008 to February 2020. All patients underwent a preprocedural transesophageal echocardiography (TEE) evaluation. The closures were carried out under fluoroscopic and ICE guidance. A follow-up visit was performed at 1, 3 and 12 months, followed by telephone evaluations approximately every 2 years. RESULTS Sixty-six patients (29% male individuals), mean age 43 ± 16 years, were treated. In 15 cases, the TEE defect diameter was less than 10 mm, and in 8 of these patients, the ICE intraprocedural sizing increased the maximum diameter by more than 5 mm. Sizing balloon of the defect was performed in 51 cases; 2 patients received an ASD 38 mm device. Eight patients had multiple defects; in three of these, it was necessary to apply two devices. Four patients showed nonsignificant residual shunt; no complications related to the use of ICE were observed. One patient presented the migration of the ASD device into the abdominal aorta, percutaneously retrieved with a snare. No major complications were recorded during the entire follow-up period. CONCLUSION This study confirms that ICE monitoring during ASD percutaneous closure is well tolerated and effective; it might be achievable as a routine gold standard by operators willing to use ICE systematically in all transcatheter closure interventions of interatrial communications.
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Affiliation(s)
- Katya Lucarelli
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Tommaso Acquaviva
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | | | - Emanuela De Cillis
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | - Vito Casamassima
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Eloisa Basile
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Elia Iorio
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Giacomo Cecere
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Pierpaolo Petti
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Rosa Caruso
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Alessandro Bortone
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | - Massimo Grimaldi
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Massimo Chessa
- ACHD Unit Head, IRCCS Policlinico San Donato & Vita Salute San Raffaele University, Milan, Italy
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Lee SH, Oh S, Ko YG, Lee YJ, Lee SJ, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko KY, Cho I, Shim CY, Hong GR, Choi D, Hong MK. Comparison of Intracardiac Echocardiography Versus Transesophageal Echocardiography for Guidance During Transcatheter Aortic Valve Replacement. Korean Circ J 2024; 54:63-75. [PMID: 38111184 PMCID: PMC10864253 DOI: 10.4070/kcj.2023.0195] [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: 07/10/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. METHODS This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. RESULTS Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEE-GA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53-1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23-2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2-4 bleeding. CONCLUSIONS ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.
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Affiliation(s)
- Sang-Hyup Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seunguk Oh
- Department of Cardiology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Yong-Joon Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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4
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Seo M, Kikuchi A, Watanabe T, Yamada T, Shirakawa Y. Intracardiac Echocardiography-Guided Transcatheter Edge-to-Edge Repair for Mitral Regurgitation. CASE (PHILADELPHIA, PA.) 2024; 8:11-15. [PMID: 38264615 PMCID: PMC10801807 DOI: 10.1016/j.case.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
•We occasionally encounter situations in which TEE is contraindicated. •ICE can be an effective alternative imaging guidance for mitral TEER. •The hybrid approach using TTE is effective to make ICE-guided TEER successful.
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Affiliation(s)
- Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
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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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Ding X, Xiang K, Qian C, Hou X, Wu F. Intracardiac echocardiography is a promising strategy for guiding closure of the left atrial appendage. Health Sci Rep 2023; 6:e1762. [PMID: 38116174 PMCID: PMC10728371 DOI: 10.1002/hsr2.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Background and Aims Percutaneous transcatheter left atrial appendage (LAA) closure (LAAC) is an effective approach for preventing ischemic stroke in nonvalvular atrial fibrillation patients. Intracardiac echocardiography (ICE), a new imaging modality, is a promising strategy for guiding LAAC. This review highlights the various strategies for ICE-guided-LAAC as an option for clinical policy. Methods A comprehensive literature search was conducted of PubMed, ScienceDirect, Ovid Web of Science, SpringerLink, and other notable databases to identify recent peer-reviewed clinical trials, reviews, and research articles related to ICE and its application in the guidance of LAAC. Results Various methods are used to evaluate the spatial structure and dimensions of the LAA. The main techniques for guiding LAAC are transesophageal echocardiography (TEE), cardiac computed tomography (CTA), and ICE. Among these techniques, the advantages of ICE typically include (1) multiangle and real-time assessment of intracardiac structure, (2) a reduction in procedural fluoroscopy, (3) reduced operation time and improved workflow in the catheterization laboratory, and (4) the avoidance of general anesthesia and the early detection of complications. Conclusion ICE is a promising strategy for the guidance of LAAC. Among the most advanced and recent technological innovations in cardiovascular imaging in general and volume imaging in particular, ICE offers greater efficacy and safety.
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Affiliation(s)
- Xueyan Ding
- Department of CardiologySir Run Run Shaw Hospital Zhejiang University School of MedicineHangzhouZhejiangP.R. China
| | - Kefa Xiang
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
| | - Congli Qian
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
| | - Xu Hou
- Bengbu Medical CollegeBengbuAnhuiP.R. China
| | - Feng Wu
- Department of Cardiology, The 72nd Group Army HospitalHuzhou UniversityHuzhouZhejiangP.R. China
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Zhang X, Gosnell J, Nainamalai V, Page S, Huang S, Haw M, Peng B, Vettukattil J, Jiang J. Advances in TEE-Centric Intraprocedural Multimodal Image Guidance for Congenital and Structural Heart Disease. Diagnostics (Basel) 2023; 13:2981. [PMID: 37761348 PMCID: PMC10530233 DOI: 10.3390/diagnostics13182981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Percutaneous interventions are gaining rapid acceptance in cardiology and revolutionizing the treatment of structural heart disease (SHD). As new percutaneous procedures of SHD are being developed, their associated complexity and anatomical variability demand a high-resolution special understanding for intraprocedural image guidance. During the last decade, three-dimensional (3D) transesophageal echocardiography (TEE) has become one of the most accessed imaging methods for structural interventions. Although 3D-TEE can assess cardiac structures and functions in real-time, its limitations (e.g., limited field of view, image quality at a large depth, etc.) must be addressed for its universal adaptation, as well as to improve the quality of its imaging and interventions. This review aims to present the role of TEE in the intraprocedural guidance of percutaneous structural interventions. We also focus on the current and future developments required in a multimodal image integration process when using TEE to enhance the management of congenital and SHD treatments.
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Affiliation(s)
- Xinyue Zhang
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, China; (X.Z.); (B.P.)
| | - Jordan Gosnell
- Betz Congenital Health Center, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA; (J.G.); (S.H.); (M.H.)
| | - Varatharajan Nainamalai
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA; (V.N.); (S.P.)
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI 49931, USA
| | - Savannah Page
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA; (V.N.); (S.P.)
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI 49931, USA
| | - Sihong Huang
- Betz Congenital Health Center, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA; (J.G.); (S.H.); (M.H.)
| | - Marcus Haw
- Betz Congenital Health Center, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA; (J.G.); (S.H.); (M.H.)
| | - Bo Peng
- School of Computer Science, Southwest Petroleum University, Chengdu 610500, China; (X.Z.); (B.P.)
| | - Joseph Vettukattil
- Betz Congenital Health Center, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA; (J.G.); (S.H.); (M.H.)
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA; (V.N.); (S.P.)
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA; (V.N.); (S.P.)
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI 49931, USA
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Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Pontone G, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Donal E. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging 2023; 24:e209-e268. [PMID: 37283275 DOI: 10.1093/ehjci/jead096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, 26th Street, Dubai, United Arab Emirates
| | - Eric Brochet
- Cardiology Department, Hopital Bichat, 46 rue Huchard, Paris 75018, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesco Faletra
- Senior SHD Consultant Istituto Cardiocentro Via Tesserete 48, CH-6900 Lugano, Switzerland
- Senior Imaging Consultant ISMETT UPCM Hospital, Discesa dei Giudici, 4, 90133 Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh-Heart & Vascular Institute UPMC, 200 Lothrop St Ste E354.2, Pıttsburgh, PA 15213, USA
- Cardiology Department, Baskent University, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nina Wunderlich
- Asklepios Klinik Langen Röntgenstrasse 20, Langen 63225, Germany
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
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Raja Shariff RE, Soesanto AM, Scalia GM, Ewe SH, Izumo M, Liu L, Li WCW, Kam KKH, Fan Y, Hong GR, Kinsara AJ, Tucay ES, Oh JK, Lee APW. Echocardiographic Imaging in Transcatheter Structural Intervention: An AAE Review Paper. JACC. ASIA 2023; 3:556-579. [PMID: 37614546 PMCID: PMC10442887 DOI: 10.1016/j.jacasi.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 08/25/2023]
Abstract
Transcatheter structural heart intervention (TSHI) has gained popularity over the past decade as a means of cardiac intervention in patients with prohibitive surgical risks. Following the exponential rise in cases and devices developed over the period, there has been increased focus on developing the role of "structural imagers" amongst cardiologists. This review, as part of a growing initiative to develop the field of interventional echocardiography, aims to highlight the role of echocardiography in myriad TSHIs available within Asia. We first discuss the various echocardiography-based imaging modalities, including 3-dimensional echocardiography, fusion imaging, and intracardiac echocardiography. We then highlight a selected list of structural interventions available in the region-a combination of established interventions alongside novel approaches-describing key anatomic and pathologic characteristics related to the relevant structural heart diseases, before delving into various aspects of echocardiography imaging for each TSHI.
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Affiliation(s)
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | | | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Miyamae Ward, Kawasaki, Kanagawa, Japan
| | - Liwen Liu
- Department of Ultrasound, Xijing Hypertrophic Cardiomyopathy Center, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Williams Ching-Wei Li
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kevin Ka-Ho Kam
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
| | - Yiting Fan
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Geu-Ru Hong
- Yonsei University College of Medicine, Sinchon-dong, Seodaemun-gu, Seoul, South Korea
| | - Abdulhalim Jamal Kinsara
- Ministry of National Guard—Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Edwin S. Tucay
- Philippine Heart Center, Diliman, Quezon City, Metro Manila, Philippines
| | - Jae K. Oh
- Mayo Clinic, Rochester, Minnesota, USA
| | - Alex Pui-Wai Lee
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
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10
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Laterra G, Artale C, Sacchetta G, Contarini M. Intracardiac echocardiography probe via oesophageal to guide percutaneous left atrial appendage closure procedure: a case series. Eur Heart J Case Rep 2023; 7:ytad261. [PMID: 37360008 PMCID: PMC10285631 DOI: 10.1093/ehjcr/ytad261] [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: 08/09/2022] [Revised: 11/09/2022] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
Background Left atrial appendage closure (LAAC) can be an alternative to oral anticoagulant therapy in patients with non-valvular atrial fibrillation, characterized by high risk of stroke (CHA2D2VASC ≥ two for men and CHA2D2VA2SC ≥ three for women) and high risk of bleeding (HASBLED = 3). Case summary We describe three case reports in which an intracardiac echocardiography probe was used via the oesophageal route as an alternative to traditional transoesophageal echocardiography (TEE) or ICE methods to guide LAAC. Guiding the procedure via conventional TEE, even if feasible, could be difficult in these patients due to different causes: one patient was affected by Brugada syndrome while the other two patients reported oropharyngeal abnormalities. For these reasons, we performed an alternative use of the ICE probe to guide the entire LAAC procedure. Discussion Currently, LAAC is performed using intracardiac or transoesophageal echocardiography. This alternative use of ICE probe via oesophageal (ICE-TEE) is reported in previous studies that describe the feasibility of this technique both in excluding the presence of thrombus in left atrial appendage before cardioversion and in guiding percutaneous foramen ovale closure. Therefore, the ICE probe has been used as an intraoperative transoesophageal echocardiographic probe to repair congenital heart disease in infants or children with oropharyngeal abnormalities.This case series reports the first use of ICE-TEE to guide the entire LAAC procedure, guaranteeing the visualization of all echocardiographic views needed to perform it. The present case series highlights the potential of ICE-TEE to safely perform both pre-procedural and intraoperative evaluations in LAAC procedure.
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Affiliation(s)
| | - Claudia Artale
- Interventional Cardiology Unit, Umberto I Hospital Testaferrata 1, 96100 Siracusa, Italy
| | - Giorgio Sacchetta
- Interventional Cardiology Unit, Umberto I Hospital Testaferrata 1, 96100 Siracusa, Italy
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11
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Alkhouli M, Nielsen-Kudsk JE. The Case for Intracardiac Echo to Guide Left Atrial Appendage Closure. Card Electrophysiol Clin 2023; 15:151-156. [PMID: 37076227 DOI: 10.1016/j.ccep.2023.01.010] [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: 04/21/2023]
Abstract
Left atrial appendage closure (LAAC) has become a commonly used alternative to anticoagulation for stroke prevention in patients with atrial fibrillation. There is a growing interest in adopting a minimally invasive procedural approach using intracardiac echocardiography (ICE) and moderate sedation. In this article, we review the rational for and the data supporting ICE-guided LAAC and discuss the pros and cons of this approach.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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12
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Prandi FR, Lerakis S, Belli M, Illuminato F, Margonato D, Barone L, Muscoli S, Chiocchi M, Laudazi M, Marchei M, Di Luozzo M, Kini A, Romeo F, Barillà F. Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives. J Clin Med 2023; 12:jcm12103384. [PMID: 37240489 DOI: 10.3390/jcm12103384] [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: 03/22/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Severe tricuspid valve (TV) regurgitation (TR) has been associated with adverse long-term outcomes in several natural history studies, but isolated TV surgery presents high mortality and morbidity rates. Transcatheter tricuspid valve interventions (TTVI) therefore represent a promising field and may currently be considered in patients with severe secondary TR that have a prohibitive surgical risk. Tricuspid transcatheter edge-to-edge repair (T-TEER) represents one of the most frequently used TTVI options. Accurate imaging of the tricuspid valve (TV) apparatus is crucial for T-TEER preprocedural planning, in order to select the right candidates, and is also fundamental for intraprocedural guidance and post-procedural follow-up. Although transesophageal echocardiography represents the main imaging modality, we describe the utility and additional value of other imaging modalities such as cardiac CT and MRI, intracardiac echocardiography, fluoroscopy, and fusion imaging to assist T-TEER. Developments in the field of 3D printing, computational models, and artificial intelligence hold great promise in improving the assessment and management of patients with valvular heart disease.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Mario Laudazi
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University, 00133 Rome, Italy
| | - Massimo Marchei
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marco Di Luozzo
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Annapoorna Kini
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Romeo
- Department of Departmental Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
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13
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Guarracini F, Bonvicini E, Preda A, Martin M, Muraglia S, Casagranda G, Mochen M, Coser A, Quintarelli S, Branzoli S, Bonmassari R, Marini M, Mazzone P. Appropriate Use Criteria of Left Atrial Appendage Closure Devices: Latest Evidences. Expert Rev Med Devices 2023; 20:493-503. [PMID: 37128658 DOI: 10.1080/17434440.2023.2208748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Atrial fibrillation is the most common arrythmia and it is linked to an increased risk of stroke. Even if anticoagulation therapy reduces the rate of stroke the benefits of this therapy have to been balanced with the increased risk of hemorrhagic event. Left atrial appendage closure is a valid alternative to long term anticoagulation in patients with atrial fibrillation and high hemorrhagic risk. Actually new devices with different features have been tested and introduced progressively in the clinical practice. Improvements preprocedural imaging evaluation and the learning curve of the operators led to percutaneous left atrial appendage closure a safe and effective procedure. A good knowledge of different devices and the technique of implant is necessary for optimization percutaneous left atrial appendage closure and the reduction of complications during the acute phase and follow up.
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Affiliation(s)
| | | | - Alberto Preda
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, Milano, Italy
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | | | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | | | | | - Patrizio Mazzone
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, Milano, Italy
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14
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Machino-Ohtsuka T, Ishizu T, Kawakami Y. Intraoperative Imaging Strategy Unique to Japan for Transcatheter Closure of Atrial Septal Defects. Circ J 2023; 87:525-526. [PMID: 36805529 DOI: 10.1253/circj.cj-23-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Tomoko Machino-Ohtsuka
- Department of Cardiology, Faculty of Medicine, University of Tsukuba.,Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Yasushi Kawakami
- Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba
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15
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Nielsen-Kudsk JE, Berti S, Caprioglio F, Ronco F, Arzamendi D, Betts T, Tondo C, Christen T, Allocco DJ. Intracardiac Echocardiography to Guide Watchman FLX Implantation: The ICE LAA Study. JACC Cardiovasc Interv 2023; 16:643-651. [PMID: 36764917 DOI: 10.1016/j.jcin.2022.10.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is increasingly used to guide left atrial appendage closure (LAAC). OBJECTIVES The aim of this study was to investigate the efficacy and safety of ICE-guided LAAC with the Watchman FLX device. METHODS The ICE LAA (I Can See Left Atrial Appendage) study was a prospective, multicenter study with independent adjudication of echocardiographic data by a core laboratory and clinical events by a clinical events committee. Patients with atrial fibrillation with CHA2DS2-VASc scores ≥2 and clinical indications for LAAC were eligible. Preplanning with either cardiac computed tomography or transesophageal echocardiography (TEE) within 7 days prior to LAAC was mandatory. Intraprocedural ICE was carried out from the left atrium. The primary outcome was the rate of significant peri-device leaks (>5 mm) at 45-day TEE. RESULTS A total of 100 patients were enrolled. The mean age was 76 ± 8 years, the mean CHA2DS2-VASc score was 4.0 ± 1.5, and the mean HAS-BLED score was 2.5 ± 0.9. The incidence of the primary outcome of significant peridevice leak (>5 mm) was 0%; all patients evaluated by TEE at 45 days had effective LAAC. All patients received Watchman FLX devices, and technical success was 100%. The number of devices per case was 1.0 ± 0.1. ICE successfully guided the assessment of device release criteria, including device compression (19.2% ± 7.1%; recommended range: 10%-30%). No subject required conversion to TEE. Procedural complications were 4 access-site bleeds. There was no stroke, transient ischemic attack, systemic embolization, pericardial effusion, device embolization, or device-related thrombus during the procedure or 45-day follow-up. CONCLUSIONS ICE can be used to successfully guide LAAC with the Watchman FLX, with excellent procedural success, a high rate of effective LAAC, and minimal periprocedural complications. (I Can See Left Atrial Appendage [ICELAA] Clinical Study; NCT04196335).
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Affiliation(s)
| | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | | | | | | | | | - Claudio Tondo
- Heart Rhythm Center at Monzino Cardiac Center, IRCCS, Department of Biomedical, Surgical and Dentist Sciences, University of Milan, Milan, Italy
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16
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Alkhouli M. The ICE LAA Study: Another Proof of Concept or a PASS to the Future? JACC Cardiovasc Interv 2023; 16:652-654. [PMID: 36764915 DOI: 10.1016/j.jcin.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
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17
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Zhu J, Zhang N, Ma Q, Jin L, Pan X. Intracardiac biopsy of cardiac tumors with echocardiographic guidance: Case report. Front Cardiovasc Med 2023; 10:1103918. [PMID: 37180777 PMCID: PMC10173306 DOI: 10.3389/fcvm.2023.1103918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Background Primary cardiac tumors are very rare, and about 20-30% of them are malignant tumors. Since early signs of cardiac tumors are non-specific, diagnosis can be challenging. There is a lack of the recommended guidelines or standardized strategies for diagnosis and optimal treatment for this disease. As the definite diagnoses of most tumors are made by pathologic confirmation, biopsied tissue is essential in determining the treatment for patients with cardiac tumors. Recently, intracardiac echocardiography (ICE) has been introduced to assist biopsy procedures of cardiac tumors and it provides high-quality imaging. Case Description Due to its low prevalence and variable presentation, cardiac malignant tumors usually are easily missed. Hereby, we report three cases of patients who presented with non-specific signs of cardiac disorder and was initially suspended diagnosis as lung infection or cancer. Under the guidance of ICE, cardiac biopsies were successfully on cardiac masses, giving critical data for diagnosis and treatment planning. No procedural complications were obtained in our cases. These cases are intended to highlight the clinical value and importance of ICE-guided biopsy of intracardiac mass. Conclusions The diagnosis of primary cardiac tumors relies on the histopathological results. In our experience, using ICE for biopsy of an intracardiac mass is an attractive tool to increase diagnostic results and reduce the risk of cardiac complications associated with inadequate targeting of the biopsy catheters.
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Affiliation(s)
- Jinyun Zhu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ning Zhang
- Department of Cardiology, the Affiliated Hangzhou First People’s Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qunchao Ma
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Luhang Jin
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohong Pan
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Correspondence: Xiaohong Pan
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18
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Wang Y, Zhao Y, Zhou K, Zei PC, Wang Y, Cheng H, Chen S, Tao Y, Mao Y, Liu Q, Bangash AB, Sheng X, Sun Y, Zhang P, Yu L, Lin J, Zhang Z, Fu G, Jiang R, Jiang C. Intracardiac echocardiography is a safe and effective alternative to transesophageal echocardiography for left atrial appendage thrombus evaluation at the time of atrial fibrillation ablation: The ICE-TEE study. Pacing Clin Electrophysiol 2023; 46:3-10. [PMID: 36301182 DOI: 10.1111/pace.14601] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) technology has been increasingly accepted as an integral part of atrial fibrillation (AF) ablation procedures. It is still unknown whether ICE can routinely replace transesophageal echocardiography (TEE) for routine thrombus screening in non-selective AF patients. OBJECTIVE To assess whether ICE can routinely replace TEE in screening for left atrial (LA)/left atrial appendage (LAA) thrombus in general patients undergoing catheter ablation for AF. METHODS A total of 2003 consecutive patients undergoing AF ablation were included. 1155 patients (ICE group) received intra-procedural ICE examination for LA/LAA thrombus screening, while 848 patients (TEE group) received pre-procedure TEE examination. The incidence of thrombus, peri-procedure complications, and hospital efficiency were assessed. RESULTS The LA and LAA were adequately visualized in all patients. Five patients in the ICE group and 15 patients in the TEE group were found to have LAA thrombus. The incidence of major periprocedural thrombo-embolic events was comparable between two groups (0.2% vs. 0.1%, p = .76), none were due to undetected LA/LAA thrombus. Other major periprocedural complications occurred at similar rates in both groups, while post-procedure fever was less common in the ICE group (12.7% vs. 17.4%, p < .001). Procedure times and hospital length of stay were both shorter in the ICE group (142 min [87-197 min] vs. 150 min [95-205 min], and 3[2-4] day vs. 4[3-5] day, respectively, both p < .001). CONCLUSIONS ICE can replace TEE for atrial thrombus screening in AF patients undergoing ablation without increased complications. An "ICE replacing TEE" workflow can also reduce the incidence of postoperative fever and improve hospital efficiency.
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Affiliation(s)
- Yuxing Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China
| | - Yi Zhao
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China
| | - Kuangshi Zhou
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China
| | - Paul C Zei
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yunhe Wang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Cheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shiquan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuhang Tao
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yankai Mao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Abdul Basit Bangash
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pei Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Yu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianwei Lin
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zuwen Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang Province, China
| | - Ruhong Jiang
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang Province, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, of Zhejiang Province, China.,Comprehensive Unit of National Regional Medical Center, Zhejiang Province, China
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19
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Ueno H, Imamura T, Tanaka S, Fukuda N, Kinugawa K. Left atrial appendage closure for stroke prevention in nonvalvular atrial fibrillation: A current overview. J Cardiol 2022; 81:420-428. [PMID: 36400415 DOI: 10.1016/j.jjcc.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and its prevalence increases with age. AF causes palpitations, heart failure, and cardiogenic embolism. Of them, the most critical and fatal complication is a cardio-embolic event. Oral anticoagulation plays a central role in reducing stroke risk in AF patients. Recently, when oral anticoagulation is considered in patients with non-valvular AF who are eligible for direct oral coagulations, they are preferred to vitamin K antagonist based on accumulating evidence. Although many patients can tolerate oral anticoagulation, there is a subset of patients who cannot tolerate long-term oral anticoagulation. Such a subset has a higher bleeding risk as indicated by the HAS-BLED score under oral anticoagulation. This subset of patients requires effective and safe non-pharmacological alternative therapies for stroke prevention. One of the promising non-pharmacological therapies is left atrial appendage closure. Three randomized controlled trials demonstrated non-inferiority of percutaneous left atrial appendage closure using WATCHMAN family to oral anticoagulation (Boston Scientific, Marlborough, MA, USA). WATCHMAN FLX, which was innovated following WATCHMAN 2.5, was associated with fewer safety events and a higher success rate of effective appendage closure. Nevertheless, several unsolved issues remain, including device-related thrombosis, post-treatment antithrombotic therapy, and peri-device leakage. Left atrial appendage closure for patients with non-valvular AF may be an alternative therapy to avoid cardiac embolism for high bleeding risk patients with contraindications to long-term oral anticoagulation therapy.
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Affiliation(s)
- Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Nobuyuki Fukuda
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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20
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Vanhaverbeke M, Nuyens P, Bieliauskas G, Sondergaard L, Vejlstrup N, De Backer O. Facilitation techniques to cross the interatrial septum with intracardiac echocardiography during left atrial appendage closure. Catheter Cardiovasc Interv 2022; 100:795-800. [PMID: 35880854 PMCID: PMC9796577 DOI: 10.1002/ccd.30348] [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: 05/05/2022] [Revised: 06/12/2022] [Accepted: 07/16/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study aimed to assess the rate of difficult interatrial septum (IAS) crossing with the intracardiac echocardiography (ICE) probe during percutaneous left atrial appendage (LAA) closure and to identify techniques that facilitate IAS crossing with the ICE probe. BACKGROUND Percutaneous LAA closure is increasingly performed by ICE guidance. Although such an approach omits the need for general anesthesia, crossing of the IAS with the ICE probe may sometimes be challenging. METHODS All consecutive patients that underwent ICE-guided percutaneous LAA closure with an Amplatzer Amulet (Abbott) or WatchmanFLX (Boston Scientific) at our center in the period 2018-2021 were included. Cases in which IAS crossing with ICE was difficult were identified and techniques used to facilitate IAS crossing were identified and listed. RESULTS In 17 (5%) out of 354 cases, IAS crossing with the ICE probe was difficult and required use of additional techniques. Ultimately, IAS crossing was also successful in these 17 cases by using one of three possible facilitation techniques: the probing technique (12 cases), the double-wire technique (3 cases), and the snaring technique (2 cases). In one case, the double-wire technique was converted to the snaring technique, as crossing of the ICE probe remained challenging despite the use of two stiff guidewires. CONCLUSION Crossing of the IAS with the ICE probe can be challenging in 5% of ICE-guided percutaneous LAA closure procedures. Operators should be aware of possible facilitation techniques in challenging cases, as these show to be safe and effective.
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21
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Gheorghe LL, Hegeman R, Vrijkorte M, Wunderlich N, Cavalcante J, Wang DD, Rana B, Vannan M, Timmers L, Swaans M. The evolving role of multi-modality imaging in transcatheter tricuspid valve interventions. Front Cardiovasc Med 2022; 9:793267. [DOI: 10.3389/fcvm.2022.793267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Tricuspid valve pathophysiology is not well-understood. Emergence of novel transcatheter tricuspid therapies has fueled the requirements for improved imaging visualization techniques and interventional imaging physician skillsets in guiding these complex transcatheter procedures. There is growing understanding on the clinical significance of tricuspid regurgitation which expanded the interest for percutaneous tricuspid valve interventions. The present review concentrates on three essential aspects of tricuspid valve pathophysiology: anatomical considerations for tricuspid interventions, optimal timing of tricuspid interventions by imaging guidance, and the role of interventional imaging physicians’ skillset and knowledge in this field.
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22
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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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Abstract
The most challenging and time-consuming step of TIPS procedures is obtaining appropriate portal vein (PV) access. Given the lack of real-time direct target visualization, conventional fluoroscopic guidance requires multiple passes, contributing to complications. In comparison, intravascular ultrasound (IVUS) guidance during TIPS procedures provides direct visualization of hepatic structures and real-time guidance for PV puncture. IVUS guidance during TIPS creation improves procedural metrics such as radiation dose, contrast agent volume, procedure time, and technical success rate and is particularly beneficial in technically challenging cases (e.g., in patients portal vein thrombosis, small or variant portal vein anatomy, Budd-Chiari syndrome, or liver masses). The purpose of this review is to summarize current IVUS technology, describe the technical aspects of IVUS-guided TIPS creation, and discuss the clinical indications for and benefits of using IVUS for TIPS creation, while presenting available evidence supporting the technique's use. Given the improved safety profile and overall success rate in comparison with conventional guidance methods, IVUS guidance has the future potential to become the standard practice for TIPS placement.
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Kawsara A, Raybuck B. Snare and track (SNACK) technique: a novel approach for successful placement of an intracardiac echocardiogram catheter in the left atrium: a case report. Eur Heart J Case Rep 2022; 6:ytac365. [PMID: 36111074 PMCID: PMC9470155 DOI: 10.1093/ehjcr/ytac365] [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: 03/09/2022] [Revised: 05/11/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Placing an intracardiac echocardiogram (ICE) catheter in the left atrium allows for excellent visualization of the left atrial appendage to guide left atrial (LA) appendage occlusion (LAAO). Nonetheless, it requires a separate septal puncture or a unique set of skills to navigate the ICE through a previously prepared septal puncture, which can be challenging.
Case summary
This report describes a novel method to insert an ICE in the left atrium through a single septal puncture utilizing a snare technique. A 76-year-old male underwent LAAO by ICE guidance. After obtaining a standard atrial septal puncture, we were unable to advance the ICE into the left atrium. Therefore, we used a loop snare to grasp the ICE catheter-tip in the right atrium and direct it into the left atrium via the prepared septal puncture by tracking a pigtail wire that we routinely place as part of the procedure. Afterward, the left atrial appendage was successfully occluded with a Watchman device (Boston Scientific, Galway, Ireland), and the patient was discharged home without complications.
Discussion
The described technique could be a helpful tool for ICE placement to the left atrium in a controlled fashion, especially when challenging anatomy is encountered.
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Affiliation(s)
- Akram Kawsara
- Department of Medicine, Division of Cardiology, West Virginia University , 1 Medical Center Dr, Morgantown, WV 26505 , USA
| | - Bryan Raybuck
- Department of Medicine, Division of Cardiology, West Virginia University , 1 Medical Center Dr, Morgantown, WV 26505 , USA
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Katsarou M, Chinnadurai P, Bismuth J, Reardon MJ. Multimodality imaging and image guidance techniques for endovascular ascending aortic repair. JTCVS Tech 2022; 15:9-17. [PMID: 36276668 PMCID: PMC9579853 DOI: 10.1016/j.xjtc.2022.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022] Open
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Colchester RJ, Zhang EZ, Beard PC, Desjardins AE. High-resolution sub-millimetre diameter side-viewing all-optical ultrasound transducer based on a single dual-clad optical fibre. BIOMEDICAL OPTICS EXPRESS 2022; 13:4047-4057. [PMID: 35991929 PMCID: PMC9352281 DOI: 10.1364/boe.459486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 05/31/2023]
Abstract
All-optical ultrasound (OpUS), where ultrasound is both generated and received using light, has emerged as a modality well-suited to highly miniaturised applications. In this work we present a proof-of-concept OpUS transducer built onto a single optical fibre with a highly miniaturised lateral dimension (<0.8 mm). A key innovation was to use a dual-clad optical fibre (DCF) to provide multimode light for ultrasound generation and single mode light for ultrasound reception. The transducer comprised a proximal section of DCF spliced to a short section of single mode fibre (SMF). Multimode light was outcoupled at the splice joint and guided within a square capillary to provide excitation for ultrasound generation. Whilst single mode light was guided to the distal tip of the SMF to a plano-concave microresonator for ultrasound reception. The device was capable of generating ultrasound with pressures >0.4 MPa and a corresponding bandwidth >27 MHz. Concurrent ultrasound generation and reception from the transducer enabled imaging via motorised pull-back allowing image acquisition times of 4 s for an aperture of 20 mm. Image resolution was as low as ~50 µm and 190 µm in the axial and lateral extents, respectively, without the need for image reconstruction. Porcine aorta was imaged ex vivo demonstrating detailed ultrasound images. The unprecedented level of miniaturisation along with the high image quality produced by this device represents a radical new paradigm for minimally invasive imaging.
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Affiliation(s)
- Richard J. Colchester
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, 43-45 Foley Street, London, W1W 7TY, UK
| | - Edward Z. Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, 43-45 Foley Street, London, W1W 7TY, UK
| | - Paul C. Beard
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, 43-45 Foley Street, London, W1W 7TY, UK
| | - Adrien E. Desjardins
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, 43-45 Foley Street, London, W1W 7TY, UK
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Blusztein DI, Lehenbauer K, Sitticharoenchai P, Cahill T, Mihatov N, Ng V, Hamid N, George I, Kodali S, Hahn RT. 3D Intracardiac Echocardiography in Mitral Transcatheter Edge-to-Edge Repair. JACC Case Rep 2022; 4:780-786. [PMID: 35818605 PMCID: PMC9270632 DOI: 10.1016/j.jaccas.2022.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022]
Abstract
Intracardiac echocardiography (ICE) has historically had limited utility in complex structural interventions. Newer 3-dimensional ICE catheters have enhanced imaging and real-time functionality. We present a novel case of mitral valve transcatheter edge-to-edge repair where transesophageal imaging was limited by massive hiatal hernia and where complementary 3D ICE imaging enabled procedural success. (Level of Difficulty: Intermediate.)
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Nisar H, Fakim D, Bainbridge D, Chen ECS, Peters T. 3D localization of vena contracta using Doppler ICE imaging in tricuspid valve interventions. Int J Comput Assist Radiol Surg 2022; 17:1569-1577. [PMID: 35588338 PMCID: PMC9463221 DOI: 10.1007/s11548-022-02660-w] [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: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
Abstract
Purpose Tricuspid valve (TV) interventions face the challenge of imaging the anatomy and tools because of the ‘TEE-unfriendly’ nature of the TV. In edge-to-edge TV repair, a core step is to position the clip perpendicular to the coaptation gap. In this study, we provide a semi-automated method to localize the VC from Doppler intracardiac echo (ICE) imaging in a tracked 3D space, thus providing a pre-mapped location of the coaptation gap to assist device positioning. Methods A magnetically tracked ICE probe with Doppler imaging capabilities is employed in this study for imaging three patient-specific TVs placed in a pulsatile heart phantom. For each of the valves, the ICE probe is positioned to image the maximum regurgitant flow for five cardiac cycles. An algorithm then extracts the regurgitation imaging and computes the exact location of the vena contracta on the image. Results Across the three pathological, patient-specific valves, the average distance error between the detected VC and the ground truth model is \documentclass[12pt]{minimal}
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\begin{document}$$({1.22 \pm 2.00})$$\end{document}(1.22±2.00)mm. For each of the valves, one case represented the outlier where the algorithm misidentified the vena contracta to be near the annulus. In such cases, it is recommended to retake the five-second imaging data. Conclusion This study presented a method for ultrasound-based localization of vena contracta in 3D space. Mapping such anatomical landmarks has the potential to assist with device positioning and to simplify tricuspid valve interventions by providing more contextual information to the interventionalists, thus enhancing their spatial awareness. Additionally, ICE can be used to provide live US and Doppler imaging of the complex TV anatomy throughout the procedure.
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Affiliation(s)
- Hareem Nisar
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada. .,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.
| | - Djalal Fakim
- Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, 339 Windermere Rd., London, ON, N6A5A5, Canada
| | - Elvis C S Chen
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada.,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.,Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada.,Department of Medical Biophysics, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
| | - Terry Peters
- Robarts Research Institute, 1151 Richmond St., London, ON, N6A5B7, Canada.,School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A3K7, Canada.,Schulic School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada.,Department of Medical Biophysics, Western University, 1151 Richmond St., London, ON, N6A3K7, Canada
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29
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Simard T, Reddy YNV, Thaden JJ, Padang R, Michelena HI, Nkomo VT, Lloyd JW, El Sabbagh A, Nishimura RA, Reeder GS, Guerrero M, Alkhouli M, Rihal CS, Eleid MF. Atrial mitral regurgitation: Characteristics and outcomes of transcatheter mitral valve edge-to-edge repair. Catheter Cardiovasc Interv 2022; 100:133-142. [PMID: 35535629 DOI: 10.1002/ccd.30224] [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: 11/07/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Mitral transcatheter edge-to-edge repair (MTEER) is an established therapeutic approach for mitral regurgitation (MR). Functional mitral regurgitation originating from atrial myopathy (A-FMR) has been described. OBJECTIVES We sought to assess the clinical, echocardiographic and hemodynamic considerations in A-FMR patients undergoing MTEER. METHODS From 2014 to 2020, patients undergoing MTEER for degenerative MR (DMR), functional MR (FMR), and mixed MR were assessed. A-FMR was defined by the presence of MR > moderate in severity; left ventricular (LV) ejection fraction (LVEF) ≥ 50%; and severe left atrial (LA) enlargement in the absence of LV dysfunction, leaflet pathology, or LV tethering. The diagnosis of A-FMR (vs. ventricular-FMR [V-FMR]) was confirmed by three independent echocardiographers. Baseline characteristics, procedural outcomes as well as clinical and echocardiographic follow-up are reported. Device success was defined as final MR grade ≤ moderate; MR reduction ≥1 grade; and final transmitral gradient <5 mmHg. RESULTS 306 patients underwent MTEER, including DMR (62%), FMR (19%), and mixed MR (19%). FMR cases included 37 (63.8%) V-FMR and 21 (36.2%) A-FMR. Tricuspid regurgitation (≥ moderate) was higher in A-FMR (80.1%) compared to V-FMR (54%) and DMR (42%). Device success did not significantly differ between A-FMR and V-FMR (57% vs. 73%, p = 0.34) or DMR (57% vs. 64%, p = 1.0). The A-FMR cohort was less likely to achieve ≥3 grades of MR reduction compared to V-FMR (19% vs. 54%, p = 0.01) and DMR (19% vs. 49.7%, p = 0.01). Patients with V-FMR and DMR demonstrated significant reductions in mean left atrial pressure (LAP) and peak LA V-wave, though A-FMR did not (LAP -0.24 ± 4.9, p = 0.83; peak V-wave -1.76 ± 9.1, p = 0.39). In follow-up, echocardiographic and clinical outcomes were similar. CONCLUSIONS In patients undergoing MTEER, A-FMR represents one-third of FMR cases. A-FMR demonstrates similar procedural success but blunted acute hemodynamic responses compared with DMR and V-FMR following MTEER. Dedicated studies specifically considering A-FMR are needed to discern the optimal therapeutic approaches.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - James W Lloyd
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Jacksonville, Florida, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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30
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Hassan AH, Alkhouli MA, Thaden JJ, Guerrero ME. 3D Intracardiac Echo-Guided Transseptal Mitral Valve-in-Valve Under Conscious Sedation: Minimalistic Approach TMVR for Same-Day Discharge. JACC Cardiovasc Interv 2022; 15:e103-e105. [PMID: 35430170 DOI: 10.1016/j.jcin.2022.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Abdalla H Hassan
- Mayo Clinic College of Medicine and Science, Department of Cardiovascular Medicine, Rochester, Minnesota, USA.
| | - Mohamad A Alkhouli
- Mayo Clinic College of Medicine and Science, Department of Cardiovascular Medicine, Rochester, Minnesota, USA
| | - Jeremy J Thaden
- Mayo Clinic College of Medicine and Science, Department of Cardiovascular Medicine, Rochester, Minnesota, USA
| | - Mayra E Guerrero
- Mayo Clinic College of Medicine and Science, Department of Cardiovascular Medicine, Rochester, Minnesota, USA
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Ricci F, Bufano G, Galusko V, Sekar B, Benedetto U, Awad WI, Di Mauro M, Gallina S, Ionescu A, Badano L, Khanji MY. Tricuspid regurgitation management: a systematic review of clinical practice guidelines and recommendations. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:238-248. [PMID: 34878111 DOI: 10.1093/ehjqcco/qcab081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
Tricuspid regurgitation (TR) is a highly prevalent condition and an independent risk factor for adverse outcomes. Multiple clinical guidelines exist for the diagnosis and management of TR, but the recommendations may sometimes vary. We systematically reviewed high-quality guidelines with a specific focus on areas of agreement, disagreement, and gaps in evidence. We searched MEDLINE and EMBASE (1 January 2011 to 30 August 2021), the Guidelines International Network International, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed (as assessed by the Appraisal of Guidelines for Research and Evaluation II tool). Three guidelines were finally retained. There was consensus on a TR grading system, recognition of isolated functional TR associated with atrial fibrillation, and indications for valve surgery in symptomatic vs. asymptomatic patients, primary vs. secondary TR, and isolated TR forms. Discrepancies exist in the role of biomarkers, complementary multimodality imaging, exercise echocardiography, and cardiopulmonary exercise testing for risk stratification and clinical decision-making of progressive TR and asymptomatic severe TR, management of atrial functional TR, and choice of transcatheter tricuspid valve intervention (TTVI). Risk-based thresholds for quantitative TR grading, robust risk score models for TR surgery, surveillance intervals, population-based screening programmes, TTVI indications, and consensus on endpoint definitions are lacking.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
- Department of Clinical Sciences, Lund University, Jan Waldenströmsgata 35-205, 22100 Malmö, Sweden
- Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Gabriella Bufano
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Victor Galusko
- Department of Cardiology, King's College Hospital, London SE5 9RS, UK
| | - Baskar Sekar
- Morriston Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Umberto Benedetto
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Wael I Awad
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Michele Di Mauro
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences,G.d' Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy
- Department of Cardiological, Metabolic and Neural Sciences, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - Mohammed Y Khanji
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, 6229 HX, Maastricht, the Netherlands
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, EC1A 7BE, UK
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
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Saef J, Jellis C, Unai S, Tan C, Dresing T, Ayoub C. Multimodality imaging evaluation of incidentally discovered intracardiac mass. Echocardiography 2022; 39:837-840. [PMID: 35505607 DOI: 10.1111/echo.15354] [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: 02/19/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022] Open
Abstract
Incidentally discovered intracardiac masses often represent diagnostic dilemmas. No guideline-directed algorithm exists for evaluation and management in these cases. Understanding the utility and limitations of different imaging modalities expedites evaluation of differential diagnoses and management, particularly when there are discordant imaging findings. This case further demonstrates that benign cardiac tumors may grow rapidly, and that new and rapid emergence of an intracardiac mass does not necessarily correlate with a diagnosis of thrombus or malignancy. It also highlights the importance of a broad differential diagnosis and a systematic management approach in patients with intracardiac masses.
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Affiliation(s)
- Josh Saef
- Department of Cardiovascular Disease, Sydell & Arnold Miller Family Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Christine Jellis
- Department of Cardiovascular Disease, Sydell & Arnold Miller Family Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Sydell & Arnold Miller Family Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Carmela Tan
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas Dresing
- Department of Cardiovascular Disease, Sydell & Arnold Miller Family Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Chadi Ayoub
- Department of Cardiovascular Disease, Mayo Clinic, Scottsdale, Arizona, USA
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Su F, Gao C, Liu J, Ning Z, He B, Liu Y, Xu Y, Yang B, Li Y, Zhang J, Zhao X, Zhang Y, Hu H, Du X, Xie R, Zhou L, Zeng J, Ruan Z, Liu H, Guo J, Wang R, Garg S, Soliman O, Holmes DR, Serruys PW, Tao L. Periprocedural Outcomes Associated With Use of a Left Atrial Appendage Occlusion Device in China. JAMA Netw Open 2022; 5:e2214594. [PMID: 35639378 PMCID: PMC9157261 DOI: 10.1001/jamanetworkopen.2022.14594] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for patients with atrial fibrillation. However, the performance of LAAO among East Asian patients is unknown. OBJECTIVE To document the procedural success rate and configurations, major adverse event rates, and antithrombotic medication regimens during and after LAAO procedures among patients in China. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, consecutive patients from 39 Chinese centers undergoing LAAO were prospectively enrolled between April 1, 2019, and October 31, 2020. Periprocedural and intraprocedural techniques and postprocedural medications were left to the surgeon's discretion. Data were analyzed from July 1 to November 1, 2021. EXPOSURE LAAO for patients with atrial fibrillation. MAIN OUTCOMES AND MEASURES The main outcomes were procedural success and complication rates periprocedure and major adverse event rates of death, stroke, systemic embolism, and bleeding events at 30 days postprocedure; the composite end point of death, stroke, and systemic embolism was also analyzed. Unadjusted and multivariable-adjusted logistic regression analyses were performed to assess the associations of periprocedural techniques (types of anesthesia, intraprocedural imaging modalities, and combined ablation procedure) with 30-day adverse events. RESULTS Among 3096 enrolled participants, 1782 participants (57.6%) were men, and the mean (SD) age was 69 (9) years. Participants had a high risk of stroke (mean [SD] cardiovascular risk score, 4.0 [1.8]) and a moderate-to-high risk of bleeding (mean [SD] bleeding risk score, 2.4 [1.2]). A total of 1287 procedures (41.6%) were performed under local anesthesia, while 493 procedures (15.9%) used only fluoroscopy guidance. In 1297 procedures (41.9%), LAAO implantation was combined with radiofrequency ablation or cryoablation for atrial fibrillation. Procedural success was achieved in 3032 patients (97.9%). At 30-day follow-up, the rate of the composite end point of death, stroke, or systemic embolism was 0.52% (95% CI, 0.32%-0.84%), and the rate of any life-threatening or major bleeding was 1.23% (95% CI, 0.90%-1.68%). No significant associations were observed between the procedural success or 30-day adverse events and the types of anesthesia (general or local), intraprocedural imaging (transesophageal echocardiography, fluoroscopy, or intracardiac echocardiography), or whether a combined ablation procedure was performed or not. In centers performing at least 40 procedures per year, compared with those performing fewer than 40 procedures per year, procedural success was significantly higher (adjusted odd ratio [aOR], 1.97; 95% CI, 1.01-3.53; P = .02) and risk of life-threatening or major bleeding was significantly lower (aOR, 0.42; 95% CI, 0.21-0.87; P = .02). CONCLUSIONS AND RELEVANCE These findings suggest that patients with a high risk of stroke and moderate to high risk of bleeding who underwent implantation of a LAAO device in Chinese centers had high rates of procedural success and low rates of short-term ischemic and bleeding events.
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Affiliation(s)
- Fangju Su
- Department of Cardiology, Xijing Hospital, Xi’an, China
- Department of Cardiology, The 940th Hospital, Lanzhou, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Xi’an, China
| | - Jianzheng Liu
- Department of Cardiology, Xijing Hospital, Xi’an, China
| | - Zhongping Ning
- Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Beng He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Liu
- Department of Cardiology, Xijing Hospital, Xi’an, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuechun Li
- Department of Cardiology, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junfeng Zhang
- Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xianxian Zhao
- Department of Cardiology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Yushun Zhang
- Department of Cardiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Hao Hu
- Department of Cardiology, The Second Affiliated Hospital of Lanzhou University, Lanzhou, China
| | - Xianfeng Du
- Department of Cardiology, Arrhythmia Center, Ningbo First Hospital, Ningbo, China
| | - Ruiqin Xie
- Department of Cardiology, The Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling Zhou
- Department of Cardiology, Nanjing First Hospital, Nanjing, China
| | - Jie Zeng
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhongbao Ruan
- Department of Cardiology, Taizhou People’s Hospital, Taizhou, China
| | - Haitao Liu
- Department of Cardiology, Xijing Hospital, Xi’an, China
| | - Jun Guo
- Department of Cardiology, Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Xi’an, China
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - David R. Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Xi’an, China
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Alkhouli M, Nielsen-Kudsk JE. The Case for Intracardiac Echo to Guide Left Atrial Appendage Closure. Interv Cardiol Clin 2022; 11:153-158. [PMID: 35361460 DOI: 10.1016/j.iccl.2021.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Left atrial appendage closure (LAAC) has become a commonly used alternative to anticoagulation for stroke prevention in patients with atrial fibrillation. There is a growing interest in adopting a minimally invasive procedural approach using intracardiac echocardiography (ICE) and moderate sedation. In this article, we review the rational for and the data supporting ICE-guided LAAC and discuss the pros and cons of this approach.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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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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Choi JH, Park KM. Catheter ablation of outflow tract ventricular arrhythmia with intracardiac echocardiography assistance. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-021-00054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractAs the indications for catheter-based electrophysiologic procedures become more diverse and complex, accurate assessment of the anatomy of intracardiac structure has become essential for the optimal clinical outcome. Since intracardiac echocardiography (ICE) was first introduced in 1980, it has become an integral part of various electrophysiologic procedures enabling accurate visualization of cardiac structures and continuous monitoring of catheter position, with integration of real-time images and electroanatomic mapping. Catheter ablation for outflow tract ventricular arrhythmias (OTVAs) has been actively performed in symptomatic patients. However, the anatomic complexity of OT serves as the biggest obstacle to obtain the optimal results. In OTVAs, ICE has played an invaluable role in precisely defining the anatomic shell of OT beyond fluoroscopy and in guiding catheter manipulation in relation to critical structures like the conduction system and coronary arteries. This review article provides detailed information on comprehensive application of ICE for catheter ablation of OTVAs.
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Morcos R, Megaly M, Saad M, Barakat AF, Rubens M, Saxena A, Elbadawi A, Kucharik M, Luna M, Garcia S, Veledar E, Maini B, Khalili H. In‐hospital outcomes of transesophageal versus intracardiac echocardiography guided left atrial appendage closure. Catheter Cardiovasc Interv 2022; 99:1572-1581. [DOI: 10.1002/ccd.30086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Ramez Morcos
- Division of Cardiology Florida Atlantic University Boca Raton Florida USA
| | - Michael Megaly
- Division of Cardiology Banner University Medical Center/University of Arizona Phoenix Arizona USA
| | - Marwan Saad
- Division of Cardiology Brown University Providence Rhode Island USA
| | - Amr F. Barakat
- Division of Cardiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
| | - Muni Rubens
- Baptist Health South Florida Miami Florida USA
- School of Public Health Florida International University Miami Florida USA
| | - Anshul Saxena
- Baptist Health South Florida Miami Florida USA
- School of Public Health Florida International University Miami Florida USA
| | - Ayman Elbadawi
- Section of Cardiology Baylor College of Medicine Houston Texas USA
| | - Michael Kucharik
- Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton Florida USA
| | - Michael Luna
- School of Medicine University of Texas Southwestern Dallas Texas USA
| | - Santiago Garcia
- Minneapolis Heart Institute Abbott Northwestern Hospital Minneapolis Minnesota USA
| | - Emir Veledar
- Baptist Health South Florida Miami Florida USA
- School of Public Health Florida International University Miami Florida USA
| | - Brijeshwar Maini
- Division of Cardiology Florida Atlantic University Boca Raton Florida USA
| | - Houman Khalili
- Division of Cardiology Florida Atlantic University Boca Raton Florida USA
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Chen YH, Wang LG, Zhou XD, Fang Y, Su L, Wu SJ, Huang WJ, Xiao FY. Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero-fluoroscopy atrial fibrillation ablation procedures. J Cardiovasc Electrophysiol 2022; 33:667-676. [PMID: 35040537 DOI: 10.1111/jce.15370] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/12/2021] [Accepted: 12/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) is sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. We aim to evaluate the clinical outcomes and safety of ICE guided LAAC within a zero-fluoroscopy catheter ablation procedure. METHODS AND RESULTS From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC were achieved in all patients. Procedure related adverse event rate was 3.6%. During the 12-month follow-up, 75.0% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA2 DS2 -VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to a single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. CONCLUSION The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yi-He Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China
| | - Liang-Guo Wang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China
| | - Xiao-Dong Zhou
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China
| | - Ying Fang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China
| | - Lan Su
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China
| | - Sheng-Jie Wu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China
| | - Wei-Jian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China
| | - Fang-Yi Xiao
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325000, Nanbaixiang, Wenzhou, Zhejiang, China
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39
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Hagemeyer D, Ali FM, Ong G, Fam NP. The Role of Intracardiac Echocardiography in Percutaneous Tricuspid Intervention: A New ICE Age. Interv Cardiol Clin 2021; 11:103-112. [PMID: 34838293 DOI: 10.1016/j.iccl.2021.09.006] [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: 10/19/2022]
Abstract
The prevalence of severe tricuspid regurgitation in older patients is high, and the clinical relevance is perceived more and more in recent years. Many of these patients are not suitable for surgery because of their age and comorbidities. Therefore, a variety of percutaneous interventions have been developed to address this unmet need. Procedural success strongly depends on adequate imaging during the intervention. Although transesophageal echocardiography is the standard of care, imaging may be limited due to anatomic factors and adverse acoustic shadowing. In this review, we discuss the current and future role of intracardiac echocardiography in tricuspid valve interventions.
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Affiliation(s)
- Daniel Hagemeyer
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. https://twitter.com/DanielHagemeyer
| | - Faeez M Ali
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand
| | - Geraldine Ong
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
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Praz F, Muraru D, Kreidel F, Lurz P, Hahn RT, Delgado V, Senni M, von Bardeleben R, Nickenig G, Hausleiter J, Mangieri A, Zamorano J, Prendergast BD, Maisano F. Transcatheter treatment for tricuspid valve disease. EUROINTERVENTION 2021; 17:791-808. [PMID: 34796878 PMCID: PMC9724890 DOI: 10.4244/eij-d-21-00695] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
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Affiliation(s)
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, and Istituto Auxologico Italiano, IRCCS, Department of Cardiological, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | | | | | | | | | | | | | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Department of Cardiology, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Antonio Mangieri
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Jose Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Bernard D. Prendergast
- Department of Cardiology, St Thomas' Hospital and Cleveland Clinic, London, United Kingdom
| | - Francesco Maisano
- Department of Cardiothoracic Surgery, IRCCS Ospedale San Raffaele, Milan, Italy
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Alkhouli M, Simard T, Killu AM, Friedman PA, Padang R. First-in-Human Use of a Novel Live 3D Intracardiac Echo Probe to Guide Left Atrial Appendage Closure. JACC Cardiovasc Interv 2021; 14:2407-2409. [PMID: 34454857 DOI: 10.1016/j.jcin.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Alkhouli M, Simard T, El Shaer A, Bird J, Nkomo VT, Freidman PA, Thaden J, Padang R. First Experience With a Novel Live 3D ICE Catheter to Guide Transcatheter Structural Heart Interventions. JACC Cardiovasc Imaging 2021; 15:1502-1509. [PMID: 34801455 DOI: 10.1016/j.jcmg.2021.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed El Shaer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jared Bird
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Freidman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Collado FMS, Lama von Buchwald CM, Anderson CK, Madan N, Suradi HS, Huang HD, Jneid H, Kavinsky CJ. Left Atrial Appendage Occlusion for Stroke Prevention in Nonvalvular Atrial Fibrillation. J Am Heart Assoc 2021; 10:e022274. [PMID: 34668395 PMCID: PMC8751840 DOI: 10.1161/jaha.121.022274] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The majority of embolic strokes in patients with nonvalvular atrial fibrillation are caused by thrombi in the left atrial appendage. It is projected that strokes related to atrial fibrillation will markedly increase in the future unless effective mitigation strategies are implemented. Systemic anticoagulation has been known to be highly effective in reducing stroke risk in patients with atrial fibrillation. However, bleeding complications and nonadherence are barriers to effective anticoagulation therapy. Surgical and percutaneous left atrial appendage occlusion devices are nonpharmacologic strategies to mitigate the challenges of drug therapy. We present a contemporary review of left atrial appendage occlusion for stroke prevention in nonvalvular atrial fibrillation. A thorough review of the history of surgical and percutaneous left atrial appendage occlusion devices, recent trials, and US Food and Drug Administration milestones of current left atrial appendage occlusion devices are discussed.
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Pearman JL, Wall SL, Chen L, Rogers JH. Intracardiac echocardiographic-guided right-sided cardiac biopsy: Case series and literature review. Catheter Cardiovasc Interv 2021; 98:1000-1005. [PMID: 33002282 DOI: 10.1002/ccd.29302] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022]
Abstract
Endomyocardial biopsy (EMB) is a common procedure used to aid in the diagnosis of diffuse myocardial diseases and, less commonly, in the diagnosis of cardiac tumors. As cardiac tumors are often found in high-risk locations (ventricular free wall or atria), precision biopsy is paramount, and additional imaging, like transesophageal echocardiography is often required for guidance. The use of intracardiac echocardiography (ICE) to guide biopsy has been described, but there is no consensus on a standardized approach. We report our institutional approach with three cases of ICE-directed EMB performed with the 2.4 mm Jawz bioptome directed with an 8.5-Fr Agilis NxT steerable introducer. All cases were performed under guidance with the AcuNav ICE probe. There were no procedural complications and a definitive diagnosis was obtained in all three cases. We also review the available published cases of ICE-guided EMB in the literature-noting the different procedural approaches, complication rate, and diagnostic yield. There were only two negative biopsies reported among the published cases and no reported complications. Our review of all these cases suggests that ICE-guidance for EMB is superior to other forms of imaging in its ease of use and high definition of right-sided cardiac structures. We also feel that the use of the Agilis steerable sheath allows for more precise directing of the bioptome and is a critical component in performing a successful targeted biopsy.
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Affiliation(s)
- Joseph L Pearman
- Internal Medicine, UC Davis Medical Center, Sacramento, California
| | - Stephen L Wall
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Lily Chen
- Internal Medicine, UC Davis Medical Center, Sacramento, California.,Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
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Eleid MF, Alkhouli M, Thaden JJ, Zahr F, Chadderdon S, Guerrero M, Reeder GS, Rihal CS. Utility of Intracardiac Echocardiography in the Early Experience of Transcatheter Edge to Edge Tricuspid Valve Repair. Circ Cardiovasc Interv 2021; 14:e011118. [PMID: 34474586 DOI: 10.1161/circinterventions.121.011118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Firas Zahr
- Department of Cardiovascular Medicine, Oregon Health and Sciences University, Portland (F.Z., S.C.)
| | - Scott Chadderdon
- Department of Cardiovascular Medicine, Oregon Health and Sciences University, Portland (F.Z., S.C.)
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.F.E., M.A., J.J.T., M.G., G.S.R., C.S.R.)
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Surkova E, Babu-Narayan SV, Semple T, Ho SY, Li W. International journal of cardiology congenital heart disease the ACHD multi-modality imaging series: Imaging of atrial septal defects in adulthood. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Transcatheter Closure of PFO and ASD: Multimodality Imaging for Patient Selection and Perioperative Guidance. J Cardiovasc Dev Dis 2021; 8:jcdd8070078. [PMID: 34357321 PMCID: PMC8306204 DOI: 10.3390/jcdd8070078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Transcatheter closure of patent foramen ovale (PFO) and secundum type atrial septal defect (ASD) are common transcatheter procedures. Although they share many technical details, these procedures are targeting two different clinical indications. PFO closure is usually considered to prevent recurrent embolic stroke/systemic arterial embolization, ASD closure is indicated in patients with large left-to-right shunt, right ventricular volume overload, and normal pulmonary vascular resistance. Multimodality imaging plays a key role for patient selection, periprocedural monitoring, and follow-up surveillance. In addition to routine cardiovascular examinations, advanced neuroimaging studies, transcranial-Doppler, and interventional transesophageal echocardiography/intracardiac echocardiography are now increasingly used to deliver safely and effectively such procedures. Long-standing collaboration between interventional cardiologist, neuroradiologist, and cardiac imager is essential and it requires a standardized approach to image acquisition and interpretation. Periprocedural monitoring should be performed by experienced operators with deep understanding of technical details of transcatheter intervention. This review summarizes the specific role of different imaging modalities for PFO and ASD transcatheter closure, describing important pre-procedural and intra-procedural details and providing examples of procedural pitfall and complications.
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Anatomic Approach to Transseptal Puncture for Structural Heart Interventions. JACC Cardiovasc Interv 2021; 14:1509-1522. [PMID: 34294395 DOI: 10.1016/j.jcin.2021.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 11/21/2022]
Abstract
The use of transseptal puncture continues to rise given the increase in left atrial cardiac interventions. The authors review an anatomic approach to transseptal puncture incorporating multimodality imaging both pre- and intraprocedurally with stepwise escalation algorithms to ensure safe and efficacious large-bore transseptal puncture.
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Simard TJ, Eleid MF. Transcatheter Tricuspid Valve Intervention: Current Perspective. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2020.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tricuspid regurgitation (TR) adversely impacts both quality of life and long-term survival, which generates interest in therapeutic approaches to mitigate these effects. Historically, therapeutic options for TR were limited to surgical approaches, which are often complicated by significant morbidity and mortality in elderly patients with multiple comorbidities. This gap in therapeutic options led to the rapid evolution of transcatheter tricuspid valve intervention (TTVI), with a wide variety of approaches pursued and early results suggesting that TTVI improves clinical outcomes. Numerous strategies, including edge-to-edge repair, annular reduction, spacers, caval valve implantation, and transcatheter tricuspid valve replacement form the basis of TTVI today. In this review, the authors discuss the current state of each approach.
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Affiliation(s)
- Trevor J Simard
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
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Rajiah P, Alkhouli M, Thaden J, Foley T, Williamson E, Ranganath P. Pre- and Postprocedural CT of Transcatheter Left Atrial Appendage Closure Devices. Radiographics 2021; 41:680-698. [PMID: 33939541 DOI: 10.1148/rg.2021200136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Transcatheter left atrial appendage (LAA) closure is an alternative to long-term anticoagulation therapy in selected patients with nonvalvular atrial fibrillation who have an increased risk for stroke. LAA closure devices can be implanted by means of either an endocardial or a combined endocardial and epicardial approach. Preprocedural imaging is key to identifying contraindications, accurately sizing the device, and minimizing complications. Transesophageal echocardiography (TEE) has been the reference standard imaging modality to assess the anatomy for LAA closure and to provide intraprocedural guidance. However, CT has emerged as a less-invasive alternative to TEE for pre- and postprocedural imaging. CT is comparable to TEE for exclusion of thrombus but is superior to TEE for the delineation of complex LAA anatomy, measurement for device sizing, and evaluation of pulmonary venous and extracardiac structures. CT provides accurate measurements of the LAA ostial diameter, landing zone diameter, and LAA length, which are vital for accurate sizing of the device. CT allows evaluation of the relationship with the pulmonary veins and other adjacent structures that can be injured during the procedure. CT also simulates procedural fluoroscopic angles and provides evaluation of the interatrial septum, which is punctured during LAA closure. CT also provides a more convenient method for the evaluation of postprocedural complications such as incomplete closure, peridevice leaking, device-related thrombus, and device dislodgement. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology (P. Rajiah, T.F., E.W.) and Department of Cardiology (M.A., J.T.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (P. Ranganath)
| | - Mohamad Alkhouli
- From the Department of Radiology (P. Rajiah, T.F., E.W.) and Department of Cardiology (M.A., J.T.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (P. Ranganath)
| | - Jeremy Thaden
- From the Department of Radiology (P. Rajiah, T.F., E.W.) and Department of Cardiology (M.A., J.T.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (P. Ranganath)
| | - Thomas Foley
- From the Department of Radiology (P. Rajiah, T.F., E.W.) and Department of Cardiology (M.A., J.T.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (P. Ranganath)
| | - Eric Williamson
- From the Department of Radiology (P. Rajiah, T.F., E.W.) and Department of Cardiology (M.A., J.T.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (P. Ranganath)
| | - Praveen Ranganath
- From the Department of Radiology (P. Rajiah, T.F., E.W.) and Department of Cardiology (M.A., J.T.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (P. Ranganath)
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