Intracardiac Echocardiogram: Feasibility, Efficacy, and Safety for Guidance of Transcatheter Multiple Atrial Septal Defects Closure

Abstract

We aimed to determine the feasibility, efficacy, success, and safety of intracardiac echocardiography (ICE) in transcatheter multiple atrial septal defect (ASD) closure. Of 185 patients with multiple ASDs who underwent transcatheter closure, 140 (76%) patients who weighed <30kg with a narrow distance between defects or in whom single device closure was anticipated were guided by ICE and 45 patients were guided by three-dimensional (3D) transesophageal echocardiography (TEE) with or without ICE. Patients in the ICE group were relatively younger and weighed less than those in the 3D TEE group (p < 0.0001). The ratio of the distance between defects >7 mm was high, and more cases required ≥2 devices in the 3D TEE group than those in the ICE group (p < 0.0001). All patients in the 3D TEE group and seven patients (5%) in the ICE group were operated on under general anesthesia (p < 0.0001). The fluoroscopic time was shorter in the ICE group (13.98 ± 6.24 min vs. 24.86 ± 16.47 min, p = 0.0005). No difference in the complete closure rate and complications was observed. ICE-guided transcatheter and 3D TEE were feasible, safe, and effective in successful multiple ASD device closures, especially for young children and patients at high risk under general anesthesia.

Transcatheter closure of atrial septal defect using intracardiac echocardiography: a two-center, retrospective study

“…Recently, Seol et al 14 highlighted the advantages of ICE monitoring compared with evaluation with 3D-TEE in the percutaneous treatment of patients with multiple interatrial defects. Otherwise, Yamano et al 13 preferred intraprocedural monitoring with TEE in complex cases treatment, as it is equipped with a multiplane mode.…”

“…Finally, the reduction of procedural radiological exposure using ICE monitoring has been demonstrated and this is particularly useful in reproductive age patients. 4,5,14 Despite these advantages, ICE-guided ASD closure is currently not considered as routine practice and different arguments are still brought in favor of traditional TEE monitoring.…”

“…On the contrary, anatomical conditions potentially unfavorable for the application of the intracardiac method are very rare and, confirming this, no patient included in our study presented limitations to the use of ICE monitoring. Finally, the reduction of procedural radiological exposure using ICE monitoring has been demonstrated and this is particularly useful in reproductive age patients 4,5,14 …”

“…Consequently, there are no univocal positions, and some authors suggest different intraprocedural ultrasound monitoring depending on anatomic ASD features. 1,13 Recently, Seol et al 14 highlighted the advantages of ICE monitoring compared with evaluation with 3D-TEE in the percutaneous treatment of patients with multiple interatrial defects. Otherwise, Yamano et al 13 preferred intraprocedural monitoring with TEE in complex cases treatment, as it is equipped with a multiplane mode.…”

Atrial Septal Defect & Patent Foramen Ovale: Features of Ultrasound Diagnostics, Treatment and Monitoring in Children at the Present Stage

“…Около 70-80% вторичных ДМПП могут быть закрыты с помощью интервенционных методик при условии наличия достаточного края для фиксации окклюдера [24]. ЭхоКГ (трансторакальная, чреспищеводная или интракардиальная) используется для оценки правильности расположения окклюдера, наличия резидуальных шунтов, венозного возврата и функции клапанов сердца [25]. Эндоваскулярно невозможно закрыть дефект с отсутствием или очень малыми краями, расположенный близко к таким структурам, как легочные или полые вены, коронарный синус и атриовентрикулярные клапаны [26].…”