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Malhotra P. Use of Computed Tomography for Left Atrial Appendage Occlusion Procedure Planning and Post-Procedure Assessment. Interv Cardiol Clin 2024; 13:19-28. [PMID: 37980064 DOI: 10.1016/j.iccl.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Transcatheter left atrial appendage occlusion (LAAO) is an alternative to systemic anticoagulation in patients with non-valvular atrial fibrillation with increased risk for thromboembolic events. Pre- and post-procedural imaging is essential for technical success, allowing practitioners to identify contraindications, select appropriate devices, and recognize procedural complications. Although transesophageal echocardiography has traditionally served as the preeminent imaging modality in LAAO, cardiac computed tomography imaging has emerged as a noninvasive surrogate given its excellent isotropic spatial resolution, multiplanar reconstruction capability, rapid temporal resolution, and large field of view.
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Affiliation(s)
- Pankaj Malhotra
- Department of Imaging, Mark Taper Imaging Center, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Taper M335, Los Angeles, CA 90048, USA; Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
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2
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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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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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Zahid S, Gowda S, Hashem A, Khan MZ, Ullah W, Kaur G, Nasir U, Rai D, Faza NN, Little SH, Valderrabano M, Goel SS. Feasibility and Safety of Intracardiac Echocardiography Use in Transcatheter Left Atrial Appendage Closure Procedures. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100510. [PMID: 39132376 PMCID: PMC11307399 DOI: 10.1016/j.jscai.2022.100510] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 08/13/2024]
Abstract
Background Left atrial appendage closure (LAAC) is usually performed under the guidance of transesophageal echocardiography (TEE). Data on the safety of intracardiac echocardiogram (ICE)-guided LAAC from a real-world population in the United States remain limited. In this study, the aim was to evaluate the trends and outcomes of ICE-guided LAAC procedures using the US National Inpatient Sample. Methods This study used the National Inpatient Sample database from quarter 4 of 2015 to 2019. We used a propensity-matched analysis and adjusted odds ratios for in-hospital outcomes/complications. A P value of <.05 was considered significant. Results We identified 61,995 weighted LAAC cases. Of these, 1410 patients had ICE-guided LAAC with a lower median age than the patients who had TEE-guided LAAC (75 vs 77 years; P ≤ .01). The use of ICE-guided LAAC increased from 1.7% in 2015 to 2.2% in 2019 (P trend = .75). Major, cardiovascular, neurologic, and pulmonary complications were similar for ICE-guided and TEE-guided LAAC on adjusted analysis. On propensity-matched analysis, the overall vascular complication rates were similar. However, retroperitoneal bleeding remained significantly higher (0.7% vs 0%) with ICE. Gastrointestinal bleeding complications were more frequent in TEE-guided LAAC (3.5% vs 2.1%). The length of stay was similar for both groups (median = 1 day; P = .23); however, ICE was associated with $1769 excess cost of hospitalization ($25,112 vs $23,343; P = .04). Conclusions ICE-guided LAAC is safer than TEE-guided LAAC, with similar rates of major complications. However, ICE use was associated with lower rates of gastrointestinal bleeding and higher rates of retroperitoneal bleeding. In addition, ICE-guided LAAC is associated with a similar length of stay but higher costs of hospitalization.
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Affiliation(s)
- Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Smitha Gowda
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Anas Hashem
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Usama Nasir
- Department of Medicine, Reading Hospital and Medical Center, Reading, Pennsylvania
| | - Devesh Rai
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Nadeen N. Faza
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Stephen H. Little
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Miguel Valderrabano
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Sachin S. Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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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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Afzal S, Piayda K, Hellhammer K, Veulemans V, Wolff G, Heidari H, Stüwe D, Kanschik D, Polzin A, Kelm M, Zeus T. Real-time echocardiography-fluoroscopy fusion imaging for left atrial appendage closure: prime time for fusion imaging? Acta Cardiol 2021; 76:1004-1012. [PMID: 33435834 DOI: 10.1080/00015385.2020.1870193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Real-time echocardiography-fluoroscopy fusion imaging (FI) merges real-time echocardiographic imaging with fluoroscopic images allowing intuitive anatomical spatial orientation during structural heart disease interventions. We aimed to assess the safety and efficacy of FI during percutaneous left atrial appendage closure (LAAC). METHODS 34 consecutive patients before (-FI) and 121 patients after (+FI) the introduction of FI for LAAC were included in a single-centre study. In-hospital safety parameters were analysed according to adverse event (AE) definition of the Munich consensus document and procedure-related parameters were assessed for efficacy. An ANCOVA was performed to investigate the influence of a learning curve. RESULTS Time until successful transseptal puncture was significantly reduced as well as total procedure time and the amount of contrast agent used (+FI/-FI:17 ± 6.35 min vs. 22 ± 8.33 min, p = 0.001; +FI/-FI: 50 min IQR 43 min - 60 min vs. 57 min IQR 45 min -70 min; p = 0.013; +FI/-FI: 70 mL, IQR 55 ml-90 mL vs. 152 mL, IQR 107 mL - 205 mL; p < 0.001). However, fluoroscopy time and dose-area product did not differ between both groups. There was no significant difference in the occurrence of in-hospital adverse events (+FI/-FI: 2.5% vs. 0%; p = 0.596). The ANCOVA revealed that the learning curve does not affect procedural efficacy parameters such as procedure time, time to transseptal puncture, amount of contrast agent and dose-area product. CONCLUSIONS FI for LAAC reduces the total procedure time, the time to successful transseptal puncture and periprocedural amount of contrast agent.
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Affiliation(s)
- Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Katharina Hellhammer
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Houtan Heidari
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Dominique Stüwe
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Dominika Kanschik
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
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Alkhouli M, Chaker Z, Alqahtani F, Raslan S, Raybuck B. Outcomes of Routine Intracardiac Echocardiography to Guide Left Atrial Appendage Occlusion. JACC Clin Electrophysiol 2020; 6:393-400. [DOI: 10.1016/j.jacep.2019.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/15/2019] [Accepted: 11/14/2019] [Indexed: 11/28/2022]
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Khalili H, Patton M, Taii HA, Bansal P, Brady M, Taylor J, Gurung A, Maini B. 4D Volume Intracardiac Echocardiography for Intraprocedural Guidance of Transcatheter Left Atrial Appendage Closure. J Atr Fibrillation 2019; 12:2200. [PMID: 32435343 DOI: 10.4022/jafib.2200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/14/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022]
Abstract
Background Fluoroscopy and transesophageal echocardiography (TEE) are used to guide transcatheter left atrial appendage (LAA) closure in patients with atrial fibrillation to prevent thromboembolic events. This study examines whether real-time three-dimensional volume ICE guidance (4D volume ICE) can be used as an alternative to TEE during LAA closure (LAAC). Methods and Results Fifteen patients with atrial fibrillation (AF), who had high risk for stroke and contraindication for long-term warfarin therapy, were enrolled in the study. The WATCHMAN device was used for transcatheter LAAC under fluoroscopy. LAA and device sizing was performed using TEE and volume ICE guidance from the right heart. Intraprocedural ICE measurements were consistent with TEE; LAA maximal width and depth, and maximal diameter of the implanted device were moderately correlated (Pearson's coefficient: 0.63, 0.65, and 0.71 respectively; p<0.05) with good agreement (bias: -0.03 cm, -0.07 cm, and 0.003 cm respectively). The average imaging success rate, defined by the number of patients with all the required intraprocedural measurements, was 67% for ICE and 100% for TEE. The WATCHMAN device was successfully implanted in all patients with a device to patient ratio of 1.33. Conclusions 4D volume ICE can be used as an intraprocedural sizing and guidance tool for transcatheter LAAC with measurements comparable to TEE. Challenging patient characteristics significantly degrade the diagnostic image quality when imaging from the right heart. Standardized workflow with proper patient selection and optimal preprocedural planning may improve the diagnostic quality of volume ICE guidance for transcatheter LAAC procedure.
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Affiliation(s)
| | | | - Haider Al Taii
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Priya Bansal
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | | | | | | | - Brijeshwar Maini
- Tenet Healthcare Corporation, Delray Beach, FL.,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
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Intracardiac Echocardiography for Endovascular Left Atrial Appendage Closure. JACC Cardiovasc Interv 2017; 10:2207-2210. [DOI: 10.1016/j.jcin.2017.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 12/21/2022]
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10
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Afzal S, Veulemans V, Balzer J, Rassaf T, Hellhammer K, Polzin A, Kelm M, Zeus T. Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy. Neth Heart J 2016; 25:131-136. [PMID: 27966185 PMCID: PMC5260626 DOI: 10.1007/s12471-016-0937-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aims Visual guidance through echocardiography and fluoroscopy is crucial for a successful transseptal puncture (TSP) in a prespecified region of the fossa ovalis. The novel EchoNavigator system Release II (EchoNav II, Philips Healthcare, Andover, Massachusetts, USA) enables the real-time fusion of fluoroscopic and echocardiographic images. We evaluated this new imaging method in respect to safety and efficacy of TSP during MitraClip implantation and left atrial appendage closure. Methods Forty-four patients before (−EchoNav) and 44 patients after (+EchoNav) the introduction of real-time fusion were included in our retrospective, single-centre study. The primary endpoint was the occurrence of adverse events due to TSP. Secondary endpoints were successful puncture at the prespecified region and time until TSP (min). Results In both groups TSP was performed successfully in the prespecified region and no adverse events occurred during or due to the accomplishment of TSP. Time until TSP was significantly reduced in the +EchoNav group in comparison with the EchoNav group (18.48 ± 5.62 min vs. 23.20 ± 9.61 min, p = 0.006). Conclusions Real-time fusion of echocardiography and fluoroscopy proved to be as safe and successful as standard best practice for TSP. Moreover, efficacy was improved through significant reduction of time until TSP.
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Affiliation(s)
- S Afzal
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - V Veulemans
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - J Balzer
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - T Rassaf
- Department of Cardiology, University Hospital Essen, Westgerman Heart-and Vascular Centre, Essen, Germany
| | - K Hellhammer
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Polzin
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - M Kelm
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - T Zeus
- Division of Cardiology, Pneumology, and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
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Donal E, Lip GYH, Galderisi M, Goette A, Shah D, Marwan M, Lederlin M, Mondillo S, Edvardsen T, Sitges M, Grapsa J, Garbi M, Senior R, Gimelli A, Potpara TS, Van Gelder IC, Gorenek B, Mabo P, Lancellotti P, Kuck KH, Popescu BA, Hindricks G, Habib G, Cosyns B, Delgado V, Haugaa KH, Muraru D, Nieman K, Cohen A. EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 2016; 17:355-83. [DOI: 10.1093/ehjci/jev354] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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12
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Wunderlich NC, Beigel R, Swaans MJ, Ho SY, Siegel RJ. Percutaneous interventions for left atrial appendage exclusion: options, assessment, and imaging using 2D and 3D echocardiography. JACC Cardiovasc Imaging 2016; 8:472-488. [PMID: 25882576 DOI: 10.1016/j.jcmg.2015.02.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/22/2015] [Accepted: 02/05/2015] [Indexed: 12/26/2022]
Abstract
Percutaneous left atrial appendage (LAA) exclusion is an evolving treatment to prevent embolic events in patients with nonvalvular atrial fibrillation. In the past few years multiple percutaneous devices have been developed to exclude the LAA from the body of the left atrium and thus from the systemic circulation. Two- and 3-dimensional transesophageal echocardiography (TEE) is used to assess the LAA anatomy and its suitability for percutaneous closure to select the type and size of the closure device and to guide the device implantation procedure in conjunction with fluoroscopy. In addition, 2- and 3-dimensional TEE is also used to assess the effectiveness of device implantation acutely and on subsequent follow-up examination. Knowledge of the implantation options that are currently available along with their specific characteristics is essential for choosing the appropriate device for a given patient with a specific LAA anatomy. We present the currently available LAA exclusion devices and the echocardiographic imaging approaches for evaluation of the LAA before, during, and after LAA occlusion.
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Affiliation(s)
| | - Roy Beigel
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; The Heart Institute, Sheba Medical Center, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
| | - Robert J Siegel
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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13
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Chung H, Jeon B, Chang HJ, Han D, Shim H, Cho IJ, Shim CY, Hong GR, Kim JS, Jang Y, Chung N. Predicting Peri-Device Leakage of Left Atrial Appendage Device Closure Using Novel Three-Dimensional Geometric CT Analysis. J Cardiovasc Ultrasound 2015; 23:211-8. [PMID: 26755929 PMCID: PMC4707306 DOI: 10.4250/jcu.2015.23.4.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 11/04/2022] Open
Abstract
Background After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incomplete occlusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAA orifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiac computerized tomography (CT) using a novel 3D analysis system. Methods We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakage as the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients without peri-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles θ and φ were defined between the IAS plane and the line, linking the LAA orifice center and foramen ovale. Results Group 2 exhibited significantly better left atrial (LA) function than group 1 (p = 0.031). Pre-procedural θ was also larger in this group (41.9° vs. 52.3°, p = 0.019). The LAA cauliflower-type morphology was more common in group 2. Overall, the patients' LA reserve significantly decreased after the procedure (21.7 mm3 vs. 17.8 mm3, p = 0.035). However, we observed no significant interval changes in pre- and post-procedural values of θ and φ in either group (all p > 0.05). Conclusion Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakage after LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidates for LAA device closure.
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Affiliation(s)
- Hyemoon Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.; Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Byunghwan Jeon
- Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.; Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Dongjin Han
- Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Hackjoon Shim
- Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - In Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.; Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, 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
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.; Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
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14
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Owais K, Mahmood F, Montealegre-Gallegos M, Khabbaz KR, Matyal R. Left Atrial Appendage, Intraoperative Echocardiography, and the Anesthesiologist. J Cardiothorac Vasc Anesth 2015; 29:1651-62. [PMID: 26321120 DOI: 10.1053/j.jvca.2015.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Khurram Owais
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Mario Montealegre-Gallegos
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kamal R Khabbaz
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Leal S, Moreno R, de Sousa Almeida M, Silva JA, Lopez-Sendon JL. Evidence-based percutaneous closure of the left atrial appendage in patients with atrial fibrillation. Curr Cardiol Rev 2013; 8:37-42. [PMID: 22845814 PMCID: PMC3394106 DOI: 10.2174/157340312801215827] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 05/08/2012] [Accepted: 05/10/2012] [Indexed: 11/24/2022] Open
Abstract
Atrial fibrillation is the most common cardiac arrhythmia, and its prevalence is increasing. Cardioembolic stroke, most of the times secondary to thrombus formation in the left atrial appendage, is its most feared and life threatening consequence. Oral anticoagulation with vitamin-K-antagonists is currently the most used prophylaxis for stroke in patients with atrial fibrillation; unfortunately, its benefits are limited by a narrow therapeutic window and an increased risk for bleeding, making it often undesired. Percutaneous occlusion of the left atrial appendage is a novel alternative strategy for cardioembolic stroke prophylaxis in patients with atrial fibrillation at a high risk of stroke but with contraindication for long-term oral anticoagulation therapy. At present, several devices have been developed specifically for percutaneous occlusion of the left atrial appendage. Current results show good feasibility and efficacy for these devices, with a high rate of successful implantation, although also associated with the inherent potential periprocedural complications. This work reviews the current state of the art of percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation.
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Affiliation(s)
- Silvio Leal
- Cardiovascular Intervention Unit, Cardiology Service, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
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MacDonald ST, Newton JD, Ormerod OJ. Intracardiac echocardiography off piste? Closure of the left atrial appendage using ICE and local anesthesia. Catheter Cardiovasc Interv 2010; 77:124-7. [DOI: 10.1002/ccd.22652] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Shah SJ, Bardo DME, Sugeng L, Weinert L, Lodato JA, Knight BP, Lopez JJ, Lang RM. Real-time three-dimensional transesophageal echocardiography of the left atrial appendage: initial experience in the clinical setting. J Am Soc Echocardiogr 2009; 21:1362-8. [PMID: 19041579 DOI: 10.1016/j.echo.2008.09.024] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to determine the feasibility and accuracy of a new real-time 3-dimensional (RT3D) matrix-array transesophageal echocardiographic probe for the determination of left atrial appendage (LAA) geometry. METHODS Sixty-six consecutive patients (mean age, 53 +/- 17 years) referred for 2-dimensional (2D) transesophageal echocardiography (TEE) underwent additional RT3D TEE. The feasibility of RT3D TEE for LAA geometry was studied in the first 37 patients, and 2D and RT3D transesophageal echocardiographic quantification of the LAA were compared in the subsequent 29 patients. The LAA orifice diameter and depth were measured using biplane 2D TEE, and LAA orifice area was calculated as an ellipse. LAA orifice area and depth were measured in 3D and correlated to 2D measurement and were also correlated to 64-slice cardiac computed tomography (CT) in 8 patients. RESULTS All 66 patients underwent RT3D matrix-array TEE without complication. In the feasibility study, the LAA was well visualized in 95%. In the quantitation study, 2D TEE underestimated LAA orifice area compared with 3D imaging (3.1 +/- 1.3 vs 4.2 +/- 2.2 cm(2); r = 0.55). LAA depth by 2D and 3D imaging were well correlated (3.7 +/- 0.7 vs 3.4 +/- 0.7 cm; r = 0.77). LAA orifice area on CT was well correlated with area on 3D TEE (r = 0.98) but not with area 2D TEE (r = 0.13). Bland-Altman analysis demonstrated that 2D TEE systematically underestimated LAA orifice area compared with 3D TEE (mean bias, -1.0 cm(2), with wide limits of agreement [-4.6 to 2.6 cm(2)]). In the 8 patients who underwent both 3D TEE and CT, the mean bias was 0.15 cm(2), with narrow limits of agreement (-0.50 to 0.20 cm(2)). CONCLUSIONS RT3D TEE for the visualization and quantitative analysis of LAA orifice area is feasible and correlates well with 64-slice cardiac CT.
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Affiliation(s)
- Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Hudson PA, Eng MH, Kim MS, Quaife RA, Salcedo EE, Carroll JD. A comparison of echocardiographic modalities to guide structural heart disease interventions. J Interv Cardiol 2008; 21:535-46. [PMID: 18973503 DOI: 10.1111/j.1540-8183.2008.00410.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Percutaneous techniques to treat structural heart disease are rapidly evolving based on innovative interventions and the considerable advancement in image guidance technology. While two-dimensional transthoracic and transesophageal echocardiography have been integral to procedural planning and execution, intracardiac and three-dimensional echocardiography supply unique visualization of target structures with a potential improvement in patient safety and procedural efficacy. The choice of image guidance modality is based on specific differences between imaging systems, as well as other variables including cost, patient safety, operator expertise, and complexity of procedure. We will compare the adjunctive imaging tools for structural heart disease interventions, with a focus on intracardiac echocardiography and real-time three-dimensional transesophageal echocardiography.
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Affiliation(s)
- Paul A Hudson
- Division of Cardiology, University of Colorado Denver, Aurora, Colorado 80045, USA
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