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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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Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure. Int J Cardiovasc Imaging 2020; 36:855-863. [DOI: 10.1007/s10554-020-01778-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/24/2020] [Indexed: 01/26/2023]
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Enriquez A, Saenz LC, Rosso R, Silvestry FE, Callans D, Marchlinski FE, Garcia F. Use of Intracardiac Echocardiography in Interventional Cardiology: Working With the Anatomy Rather Than Fighting It. Circulation 2019; 137:2278-2294. [PMID: 29784681 DOI: 10.1161/circulationaha.117.031343] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The indications for catheter-based structural and electrophysiological procedures have recently expanded to more complex scenarios, in which an accurate definition of the variable individual cardiac anatomy is key to obtain optimal results. Intracardiac echocardiography (ICE) is a unique imaging modality able to provide high-resolution real-time visualization of cardiac structures, continuous monitoring of catheter location within the heart, and early recognition of procedural complications, such as pericardial effusion or thrombus formation. Additional benefits are excellent patient tolerance, reduction of fluoroscopy time, and lack of need for general anesthesia or a second operator. For these reasons, ICE has largely replaced transesophageal echocardiography as ideal imaging modality for guiding certain procedures, such as atrial septal defect closure and catheter ablation of cardiac arrhythmias, and has an emerging role in others, including mitral valvuloplasty, transcatheter aortic valve replacement, and left atrial appendage closure. In electrophysiology procedures, ICE allows integration of real-time images with electroanatomic maps; it has a role in assessment of arrhythmogenic substrate, and it is particularly useful for mapping structures that are not visualized by fluoroscopy, such as the interatrial or interventricular septum, papillary muscles, and intracavitary muscular ridges. Most recently, a three-dimensional (3D) volumetric ICE system has also been developed, with potential for greater anatomic information and a promising role in structural interventions. In this state-of-the-art review, we provide guidance on how to conduct a comprehensive ICE survey and summarize the main applications of ICE in a variety of structural and electrophysiology procedures.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| | - Luis C Saenz
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia. Instituto de Cardiologia. Centro Internacional de Arritmias "Andrea Natale," Fundacion Cardioinfantil, Bogota, Colombia (L.C.S.)
| | - Raphael Rosso
- Cardiac Eletrophysiology, Cardiology Division, Tel-Aviv Souraski Medical Center, Israel (R.R.)
| | | | - David Callans
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
| | | | - Fermin Garcia
- Section of Cardiac Electrophysiology (A.E., D.C., F.E.M., F.G.)
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Kavvouras C, Vavuranakis M, Vaina S, Lampropoulos K, Bazoukis G, Tse G, Tousoulis D. Intracardiac echocardiography for percutaneous patent foramen ovale and atrial septal defect occlusion. Herz 2018; 44:445-449. [DOI: 10.1007/s00059-017-4678-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/19/2017] [Accepted: 12/29/2017] [Indexed: 12/27/2022]
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5
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Yajima S, Saito S, Toda K, Sawa Y. Intravenous retro-uterine echographic surveillance of the foetus during surgical thrombectomy for life-threatening pulmonary thromboembolism. Eur J Cardiothorac Surg 2017; 52:995-997. [PMID: 28605430 DOI: 10.1093/ejcts/ezx206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/21/2017] [Indexed: 11/14/2022] Open
Abstract
Pulmonary thromboembolism is a life-threatening disease, particularly during pregnancy. We report a case of successful cardiopulmonary resuscitation followed by surgical thrombectomy in a 35-year-old woman at 28 weeks of gestation. Intracardiac echocardiography was percutaneously located behind the uterus, and greatly assisted monitoring of the foetal condition and haemodynamic status.
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Affiliation(s)
- Shin Yajima
- Department of Cardiovascular Surgery, Osaka University, Osaka, Japan
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Osaka University, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University, Osaka, Japan
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Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, Lang RM, Rome JJ, Wang Y. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 2016; 28:910-58. [PMID: 26239900 DOI: 10.1016/j.echo.2015.05.015] [Citation(s) in RCA: 298] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Frank E Silvestry
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Laurie B Armsby
- Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, Oregon
| | | | - Craig E Fleishman
- Arnold Palmer Hospital for Children, University of Central Florida College of Medicine, Orlando, Florida
| | | | - Roberto M Lang
- University of Chicago Hospital, University of Chicago School of Medicine, Chicago, Illinois
| | - Jonathan J Rome
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yan Wang
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
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7
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Azzalini L, de Hemptinne Q, Asgar A, Ibrahim R. Right atrial mass in a patient with breast cancer: percutaneous transcatheter biopsy under intracardiac echocardiography guidance. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-215146. [PMID: 27068834 DOI: 10.1136/bcr-2016-215146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Precise diagnosis of intracardiac masses is fundamental to their treatment. However, the findings of non-invasive imaging techniques are frequently inconclusive. In this setting, percutaneous transcatheter biopsy might represent a valid alternative to surgical biopsy. Intracardiac echocardiography (ICE)-guided biopsy offers high-quality imaging, is a relatively quick and easy interventional procedure to perform and does not require patient intubation or the assistance of an echocardiographer. We describe the case of a 47-year-old woman undergoing chemotherapy for breast cancer, who presented with a right atrial mass. Non-invasive imaging was inconclusive. Since no changes in the aspect or size of the mass were noticed after 2-week treatment with heparin, ICE-guided biopsy was performed, which confirmed the thrombotic nature of the mass. The patient underwent surgical resection of the thrombus and curative treatment of her breast cancer was pursued.
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Affiliation(s)
- Lorenzo Azzalini
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | | | - Anita Asgar
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | - Reda Ibrahim
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
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8
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Awad SM, Masood SA, Gonzalez I, Cao QL, Abdulla RI, Heitschmidt MG, Hijazi ZM. The use of intracardiac echocardiography during percutaneous pulmonary valve replacement. Pediatr Cardiol 2015; 36:76-83. [PMID: 25070389 DOI: 10.1007/s00246-014-0967-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/11/2014] [Indexed: 11/30/2022]
Abstract
High-quality live imaging assessment of cardiac valves and cardiac anatomy is crucial for the success of catheter-based procedures. We present our experience using Intracardiac echocardiography (ICE) during transcatheter Percutaneous Pulmonary Valve replacement (tPVR).This is a retrospective study that included 35 patients who underwent tPVR between April 2008 and June 2012. Thirty-one of these patients had the procedure performed under continuous ICE guidance. Pre-procedure transthoracic echocardiography (TTE) was obtained in all patients. ICE was performed at baseline, during the procedure, and at the conclusion of the procedure. Comparisons between the pre-procedure TTE and baseline ICE data and between post-procedure ICE data and the following day TTE were performed. Total of 35 patients had tPVR during the above-mentioned time period. Twenty-one patients received the Edwards Sapien valve and 14 patients had the Melody valve. Thirty-one patients had the procedure performed under continuous ICE guidance. The mean Pre-TTE peak gradient (PG) and Pre-ICE-PG were 45.5 ± 20 vs 33 ± 13 mmHg (p < 0.001) and the mean Pre-TTE mean gradient (MG) and Pre-ICE-MG were 27.7 ± 13 vs 21 ± 18 mmHg (p < 0.001). The mean Post-TTE- PG and Post-ICE-PG were 24.3 ± 11 vs 15.3 ± 7 mmHg (p < 0.001) and the mean of the Post-TTE-MG and Post-ICE-MG were 14.2 ± 7 vs 8.4 ± 4 mmHg (p < 0.001). There was a good correlation between peak ICE and TTE gradient at baseline and after valve placement. For the degree of pulmonary regurgitation, there was no significant difference between TTE and ICE. ICE is an important modality to guide tPVR in patients with dysfunctional homograft valve between the right ventricle and pulmonary artery and should be used to assess valve function before, during and immediately after the procedure.
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Affiliation(s)
- Sawsan M Awad
- Rush Centre for Congenital and Structural Heart Disease, Rush University Medical Centre, Chicago, IL, 60612, USA,
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9
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Dauphin C, Chalard A, Lusson JR. Intracardiac Echocardiography of Ebstein's Anomaly. Echocardiography 2014; 31:E232-3. [DOI: 10.1111/echo.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Claire Dauphin
- CHU Clermont-Ferrand; Hôpital Gabriel Montpied; Service de cardiologie et maladies vasculaires; Clermont-Ferrand France
| | - Aurélie Chalard
- CHU Clermont-Ferrand; Hôpital Gabriel Montpied; Service de cardiologie et maladies vasculaires; Clermont-Ferrand France
| | - Jean-René Lusson
- CHU Clermont-Ferrand; Hôpital Gabriel Montpied; Service de cardiologie et maladies vasculaires; Clermont-Ferrand France
- CHU Clermont-Ferrand; Clermont-Ferrand France
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10
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Bartel T, Müller S. Contemporary echocardiographic guiding tools for device closure of interatrial communications. Cardiovasc Diagn Ther 2013; 3:38-46. [PMID: 24282743 DOI: 10.3978/j.issn.2223-3652.2013.02.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/25/2013] [Indexed: 11/14/2022]
Abstract
Periinterventional echocardiographic guidance is considered desirable in order to make interventional closure of interatrial communications safe and straight forward. Transesophageal echocardiography (TEE) including real-time three-dimensional (RT-3D) imaging, later complemented and in part replaced by intracardiac echocardiography (ICE), has become established as the standard approach to guide those procedures. Especially in atrial septal defect (ASD) closure, which tends to be more challenging than patent foramen ovale (PFO) closure, a certain risk of severe complications remains and may result from suboptimal device performance. Other complications may be related to discontinuous use of echocardiographic monitoring. Image fusion and RT-3D ICE are currently under clinical testing and might be suitable to facilitate spatial orientation. Nowadays, two-dimensional ICE is the method of choice for guiding percutaneous device closure, especially of ASDs and "complex" PFOs. Uninterrupted TEE under deep sedation is an alternative. In contrast, closure of "simple" PFOs will often require nothing but final confirmation of the result, and therefore, short echocardiographic viewing is sufficient in many cases.
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Affiliation(s)
- Thomas Bartel
- Department of Medicine, Cardiology Division (Cardiology), Innsbruck Medical University, Austria
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11
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12
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Bartel T, Muller S. Device closure of interatrial communications: peri-interventional echocardiographic assessment. Eur Heart J Cardiovasc Imaging 2013; 14:618-24. [DOI: 10.1093/ehjci/jet048] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Ali S, George LK, Das P, Koshy SKG. Intracardiac echocardiography: clinical utility and application. Echocardiography 2011; 28:582-90. [PMID: 21564275 DOI: 10.1111/j.1540-8175.2011.01395.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intracardiac echocardiography (ICE) broadens the spectrum of available echocardiographic techniques and provides the operator direct visualization of cardiac structures in real time. ICE has clear advantages over fluoroscopy, transthoracic echocardiography, and transesophageal echocardiography as the imaging modality of choice in the cardiac catheterization and electrophysiological laboratories. With the development of steerable phased array catheters with low frequency and Doppler qualities, there is marked improvement in visualization of left-sided structures from the right heart. Appropriate utilization of ICE is likely to maximize safety and efficacy of complex interventional procedures and may improve patient outcomes. Future advances in ICE imaging will further improve the ease of device guidance and, in combination with new imaging modalities, could dramatically improve other applications of echocardiography which may result in improved patient outcomes. This review describes the technical evolution of ICE, the use of ICE in guiding percutaneous interventional procedures and possible future applications of ICE in the ever-growing field of interventional cardiology.
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Affiliation(s)
- Sheharyar Ali
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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14
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Vale TA, Newton JD, Orchard E, Bhindi R, Wilson N, Ormerod OJ. Prominence of the Eustachian valve in paradoxical embolism. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:33-6. [DOI: 10.1093/ejechocard/jeq100] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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15
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Kuppahally SS, Litwin SE, Green LS, Ishihara SM, Freedman RA, Michaels AD. Utility of Intracardiac Echocardiography for Atrial Baffle Leak Closure in Repaired Transposition of the Great Arteries. Echocardiography 2010; 27:E90-3. [DOI: 10.1111/j.1540-8175.2010.01171.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Lin MC, Fu YC, Jan SL, Ho CL, Hwang B. Stretched Size of Atrial Septal Defect Predicted by Intracardiac Echocardiography. Int Heart J 2010; 51:56-9. [DOI: 10.1536/ihj.51.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ming-Chih Lin
- Department of Pediatrics and Institute of Clinical Medicine, National Yang-Ming University
- Division of Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital
- Institute of Preventive Medicine, National Taiwan University
| | - Yun-Ching Fu
- Department of Pediatrics and Institute of Clinical Medicine, National Yang-Ming University
- Division of Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital
| | - Sheng-Ling Jan
- Department of Pediatrics and Institute of Clinical Medicine, National Yang-Ming University
- Division of Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital
| | - Chi-Lin Ho
- Division of Pediatric Cardiology, Department of Pediatrics, Taichung Veterans General Hospital
| | - Betau Hwang
- Department of Pediatrics and Institute of Clinical Medicine, National Yang-Ming University
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Zaqout M, Suys B, De Wilde H, De Wolf D. Transthoracic echocardiography guidance of transcatheter atrial septal defect closure in children. Pediatr Cardiol 2009; 30:992-4. [PMID: 19458994 DOI: 10.1007/s00246-009-9456-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 03/26/2009] [Accepted: 04/18/2009] [Indexed: 11/26/2022]
Abstract
Transesophageal echocardiography (TEE) guidance is part of interventional closure of secundum atrial septal defect (ASD) in children and adults. However, sometimes TEE is impossible for technical or anatomical reasons. If available, intracardiac echocardiography can be used, but especially in children, transthoracic echocardiography (TTE) can be an easy, safe, and cheap alternative. We report two cases in which TEE was replaced by TTE during percutaneous ASD closure. In the first case VACTERL association with a surgically repaired tracheoesophageal fistula was a relative contraindication to TEE. In the second case, technical failure of the transesophageal probe occurred during the procedure. In both cases the ASD was successfully closed with an atrial septal occluder device under TTE guidance. Using TTE can be sufficient and safe in children with good imaging windows, especially from subcostal views.
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Affiliation(s)
- Mahmoud Zaqout
- Department of Pediatric Cardiology, Ghent University Hospital, 9000 Ghent, Belgium
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18
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Silvestry FE, Kerber RE, Brook MM, Carroll JD, Eberman KM, Goldstein SA, Herrmann HC, Homma S, Mehran R, Packer DL, Parisi AF, Pulerwitz T, Seward JB, Tsang TSM, Wood MA. Echocardiography-guided interventions. J Am Soc Echocardiogr 2009; 22:213-31; quiz 316-7. [PMID: 19258174 DOI: 10.1016/j.echo.2008.12.013] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A major advantage of echocardiography over other advanced imaging modalities (magnetic resonance imaging, computed tomographic angiography) is that echocardiography is mobile and real time. Echocardiograms can be recorded at the bedside, in the cardiac catheterization laboratory, in the cardiovascular intensive care unit, in the emergency room-indeed, any place that can accommodate a wheeled cart. This tremendous advantage allows for the performance of imaging immediately before, during, and after various procedures involving interventions. The purpose of this report is to review the use of echocardiography to guide interventions. We provide information on the selection of patients for interventions, monitoring during the performance of interventions, and assessing the effects of interventions after their completion. In this document, we address the use of echocardiography in commonly performed procedures: transatrial septal catheterization, pericardiocentesis, myocardial biopsy, percutaneous transvenous balloon valvuloplasty, catheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO), alcohol septal ablation for hypertrophic cardiomyopathy, and cardiac electrophysiology. A concluding section addresses interventions that are presently investigational but are likely to enter the realm of practice in the very near future: complex mitral valve repairs, left atrial appendage (LAA) occlusion devices, 3-dimensional (3D) echocardiographic guidance, and percutaneous aortic valve replacement. The use of echocardiography to select and guide cardiac resynchronization therapy has recently been addressed in a separate document published by the American Society of Echocardiography and is not further discussed in this document. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures.
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Affiliation(s)
- Frank E Silvestry
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Awad SM, Cao QL, Hijazi ZM. Intracardiac echocardiography for the guidance of percutaneous procedures. Curr Cardiol Rep 2009; 11:210-5. [DOI: 10.1007/s11886-009-0030-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Hijazi ZM, Shivkumar K, Sahn DJ. Intracardiac echocardiography during interventional and electrophysiological cardiac catheterization. Circulation 2009; 119:587-96. [PMID: 19188519 DOI: 10.1161/circulationaha.107.753046] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ziyad M Hijazi
- FAHA, L608, Pediatric Cardiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
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Chien JC, Hwang B, Fu YC, Lee PC, Hsieh KS, Jan SL. Sizing of atrial septal defects by intracardiac echocardiography for device closures. J Chin Med Assoc 2008; 71:399-405. [PMID: 18772119 DOI: 10.1016/s1726-4901(08)70090-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transcatheter closure of a secundum atrial septal defect (ASD) has become an effective method for surgical treatment. In this study, we evaluated the feasibility and accuracy of intracardiac echocardiography (ICE) for sizing ASDs compared with conventional methods. METHODS Between January 2004 and December 2006, 270 patients underwent transcatheter closure of secundum ASD by using septal occluders. For 142 patients, the procedure was guided by transesophageal echocardiography (TEE), and for 128 patients by ICE. We compared the maximal diameters of the ASDs obtained during angiocardiography, transthoracic echocardiography (TTE), ICE, and TEE with balloon-stretched sizes ascertained by using a sizing plate. RESULTS ASD diameters measured with the sizing plate were significantly correlated with those measured with ICE (r = 0.963), TEE (r = 0.912), angiography (r = 0.88), and TTE (r = 0.85). The predicted stretched diameter of the ASDs, i.e. (nonstretched diameter measured with ICE x 1.07) + 3.23 mm, agreed well with that measured by using a sizing plate (Ri = 0.974). CONCLUSION ASD diameters measured with ICE correlated with sizing-plate measurements better than those determined with TEE, angiography or TTE.
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Affiliation(s)
- Jen-Chung Chien
- Department of Pediatrics, Lo-Tung Pohai Hospital, Ilan, Republic of China
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Chien KJ, Lee CL, Huang TC, Lin CC, Weng KP, Huang SH, Hsieh KS. A noninvasive sizing method to choose fitted Amplatzer septal occluder by transthoracic echocardiography in patients with secundum atrial septal defects. Heart Vessels 2007; 22:245-50. [PMID: 17653518 DOI: 10.1007/s00380-006-0959-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 10/27/2006] [Indexed: 10/23/2022]
Abstract
To simplify the conventional procedure, we developed a technique for transcatheter closure of atrial septal defects (ASDs) under transthoracic echocardiographic (TTE) sizing without balloon sizing. At present, device closure of interatrial communication has become a well-established technique to adequately treat severe left-to-right shunt associated with ASDs. During the traditional procedure, fluoroscopy with the waist of a compliant balloon is used to determine the appropriate size of the closure device and defect sizing. Choice of adequate closure device using transthoracic echocardiography (TTE) has been hitherto unreported. Between December 2002 and August 2004, 40 patients (15 males, 25 females, mean age 11.7 +/- 7.8 years) with secundum ASDs underwent transcatheter closure at our institution. In group 1, 30 patients had the procedure by balloon sizing and TTE sizing. In 10 patients (group 2), TTE sizing was used as the sole tool for selecting device size and the device size was chosen to be based on the Amplatzer septal occluder (ASO) size and TTE size ratio in group 1. The procedure was performed under continuous transesophageal echocardiographic monitoring with general anesthesia. A correlation was found between TTE and stretched balloon sizing diameter SBD (y = 1.2645x - 1.4465; R2 = 0.9861), and between TTE size and ASO size (y = 1.3412x - 1.2864; R2 = 0.9929) in group 1. In group 2, a statistical correlation between TTE and ASO (y = 1.3419x - 0.1172; R2 = 0.9934) was also found. Good linear regression between TTE size and ASO chosen size was noted in group 1 and group 2 (R2 = 0.99). In group 2, successful device implantation was accomplished in all patients whose device size was chosen to be based on the ASO and TTE ratio in group 1. Transthoracic echocardiographic sizing is a safe and ideal method to measure interatrial defect and choose the occluding device, respectively. With our experience, the sizing based on TTE is generally easier than measurement from the balloon sizing.
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Affiliation(s)
- Kuang-Jen Chien
- Department of Pediatrics, Kaohsiung Veterans General Hospital, No. 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan
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Patel A, Cao QL, Koenig PR, Hijazi ZM. Intracardiac echocardiography to guide closure of atrial septal defects in children less than 15 kilograms. Catheter Cardiovasc Interv 2006; 68:287-91. [PMID: 16830343 DOI: 10.1002/ccd.20824] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is increasingly replacing transesophageal echocardiography (TEE) as the primary imaging technique to guide device closure of atrial septal defects (ASD). Owing to the length of the procedure, the use of TEE requires general anesthesia. Investigators have reported the usefulness of ICE in adults and children. However, little is known about the use of ICE in children whose weight is <15 kg. Therefore, this study examines the use of ICE guided secundum ASD closure in children <15 kg. METHODS Nineteen patients with a median age of 3.1 years (range 1.8-4.8), and median weight of 13.2 kg (range 8.0-14.4) underwent transcatheter occlusion (Amplatzer occluder) of a secundum ASD using ICE guidance. ICE was performed using an Acunav catheter. The ICE catheter (10 F shaft) was introduced into an 11 F sheath in a contralateral femoral vein. Diagnostic as well as periprocedure imaging was obtained. RESULTS Sixteen patients had single, and three had multiple defects. Median defect size as measured by ICE was 16 mm (range 2.5-25). The median balloon stretched diameter (obtained in eight patients) was 18 mm (range 10-21); the median size of the defect for these eight patients was 15 mm (range of 8-20). Both techniques for measuring the defect correlated well with r = 0.94. The ASD occluder size ranged from 7 to 26 mm with a median of 18 mm. The procedure was successful in 16 patients who had a device implanted and no residual shunt. ASD occlusion was not attempted in two patients due to deficient rims and in one patient, the attempt failed due to left atrial disk prolapse through the ASD. Four patients experienced transient complications during the catheter procedure, including supra ventricular tachycardia, sinus bradycardia, and two with complete heart block (resolving with device removal); all had subsequent successful device placement. No complications were attributed to the use of ICE and specifically, no vascular injury was noted. CONCLUSIONS Comparable to results with larger patients, ICE provides adequate imaging (preprocedure diagnosis and periprocedure guidance) during device occlusion of secundum ASDs with no significant complications. Thus, ICE can successfully be used in the closure of ASD in smaller patients (<15 kg) and eliminate the need for endotracheal intubation.
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Affiliation(s)
- Angira Patel
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
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Koenig P, Cao QL. Echocardiographic guidance of transcatheter closure of atrial septal defects: is intracardiac echocardiography better than transesophageal echocardiography? Pediatr Cardiol 2005; 26:135-9. [PMID: 15868327 DOI: 10.1007/s00246-004-0952-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transcatheter closure of atrial septal defects is an established practice. The imaging method best suited for guidance of this procedure is under debate. This review highlights the areas of disagreement and presents available evidence supporting the contention that intracardiac echocardiography is at least as good, if not a superior imaging method to guide the procedure. Points of discussion include comparisons of imaging capability, complications or discomfort, and the relative costs of these procedures. It is concluded that intracardiac echocardiography is the superior imaging method.
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Affiliation(s)
- P Koenig
- Children's Hospital and Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA.
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Bacha EAM, Hijazi ZM. Hybrid procedures in pediatric cardiac surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005:78-85. [PMID: 15818362 DOI: 10.1053/j.pcsu.2005.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Hybrid pediatric cardiac surgery is an emerging field that combines skills and techniques used by pediatric cardiac surgeons and interventional pediatric cardiologists. This article describes the emerging indications and techniques in hybrid pediatric cardiac surgery and discusses potential future applications. It focuses on peratrial and perventricular septal defect closure, intraoperative stenting, hybrid stage I palliation for hypoplastic left heart syndrome, and percutaneous valve implantation.
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Affiliation(s)
- Emile A M Bacha
- Section of Cardiothoracic Surgery (Congenital and Pediatric Cardiac Surgery), The University of Chicago Children's Hospital, IL 60637, USA
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Cragun DT, Lax D, Butman SM. Look before you close: Atrial septal defect with undiagnosed partial anomalous pulmonary venous return. Catheter Cardiovasc Interv 2005; 66:432-5. [PMID: 16208710 DOI: 10.1002/ccd.20511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The growing and continued success of percutaneous closure of atrial defects is related to its high benefit-to-risk ratio in appropriately selected patients. The following case illustrates a previously undocumented danger, namely, the potential for incomplete correction. A thorough transesophageal examination performed at the time of the planned atrial defect closure suggested the presence of a partial anomalous pulmonary vein insertion, which was then appropriately documented and the incomplete closure was averted.
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Affiliation(s)
- David T Cragun
- University of Arizona Sarver Heart Center, University of Arizona, Tucson, Arizona, USA
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