The use of echocardiography in pediatric interventional cardiac catheterization procedures

An In vitro Study of Guidewire-Related Color Doppler Twinkling Artifacts in Echocardiography

Purpose:

This study sought to determine the association between twinkling artifacts on color Doppler ultrasound and different types of guidewires.

Materials and Methods:

Twenty-two commonly used guidewires were classified into three groups according to decreasing diameter (Group 1, 0.035”; Group 2, 0.018”; and Group 3, 0.014”) and tested in vitro. Severity of twinkling was visually graded into four categories (0–3, from weak to strong).

Results:

The percentages (tips/shafts) of twinkling artifacts were 100%/100% for Group 1; 0%/33.3% for Group 2; and 18.8%/31% for Group 3. The mean scores (tips/shafts) were 2.3/2.7 for Group 1; 0/0.3 for Group 2; and 0.3/0.4 for Group 3. Among them, both two guidewires with strong twinkling artifacts (score = 3) exhibited extensive rough surfaces on microscopic pictures.

Conclusion:

The twinkling artifacts were more likely to present in guidewires with larger diameters (from 0.014” to 0.035”) in our study settings. The surface roughness may be the contribution to the twinkling artifact. Internal heterogeneities, such as types of material, types of coating, tip loading, and spring coil length, do not show influence on the twinkling artifact.

Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients

BACKGROUND

Interventional closure of atrial septal defects (ASDs) with a transcatheter device is the preferred strategy in children and adults. This procedure has been proven in numerous studies, but X-ray and contrast agent exposure is still a major side effect. The aim of this study was to clarify whether the interventional closure of ASDs is possible and safe if it is guided by transesophageal echocardiography (TEE) alone.

METHODS AND RESULTS

We retrospectively selected and studied pediatric and adult patients with interventional closure of ASDs at the Deutsches Herzzentrum Berlin (DHZB) without fluoroscopy between 1999 and 2010. We included 330 out of 1,605 patients; 254 had an ASD II, 30 a PFO and 46 multiperforated atrial septum. Median age was 8.92 (0.96-76.3) years and median body weight 32.6 (8.3-156) kg. Median stretched defect size was 13 (5-29) mm. Median procedure time was 50 (20-170) min. Closure was performed in the majority of patients with the Amplatzer(®) septal occluder or Amplatzer(®) PFO occluder. The procedure succeeded in 98.2 % of cases and closure rate was 94.9 % after 48 h. Complication rate was low and procedure time was similar to that necessary with studies using fluoroscopy.

CONCLUSION

Interventional closure of ASDs is safe and effective if guided with TEE alone. The results can compete with those with the use of fluoroscopy. TEE-guided closure of ASD should be considered in more catheter laboratories to avoid unnecessary radiation exposure for the patient and the examiner.

Transesophageal echocardiographic guidance of blade atrial septostomy in children

Transesophageal echocardiography (TEE) was used to guide blade atrial septostomy in children requiring decompression of right or left atrium. In conjunction with biplane fluoroscopy, TEE was used to position the blade septostomy catheter and to monitor the pullback from left atrium to right atrium. Subsequent balloon dilatation of atrial septum was also carried out under TEE control. The use of TEE monitoring facilitated the procedure by providing optimal views of intracardiac structures while also limiting the total radiation exposure.