Intracardiac echocardiography. A new tool in the cath lab

Abstract

In response to the article by Zanchetta et al. (Int. J. Cardiovasc. Imaging 21,[391][392][393][394][395][396][397][398][399][400][401] In this volume, Zanchetta et al. [1] validate intracardiac echocardiography (ICE) by correlating the ICE images with anatomic sections and magnetic resonance scan planes.Interventional cardiac procedures, as for electrophysiology and interventions in congenital heart disease, have always been performed under fluoroscopic guidance and/or transesophageal echocardiography. Fluroscopy only produces global representation of the heart, necessitates an experienced skills level of the physician. Transesophageal echocardiography requires the presence of an ultrasound physician and an anesthesiologist to assist in procedures such as closure of atrial septum defects, patent foramen ovale, and more. These procedures can gain benefit by reducing Xray time, eliminating heavy sedation and discomfort and aspiration risk associated with transesophageal echocardiography and by simplifying the procedure into a single-operator action. The need for a feasible and accurate alternative imaging modality was obvious.Current intracardiac echocardiography catheters are flexible by its ability to move in four directions (anterior-posterior, and left-right position) up to 160°. They can be connected to standard and laptop size ultrasound machines. The high resolution images reveal critical information about cardiac anatomy, great vessels, blood flow direction and velocity, and the position of devices. This rapidly makes the ultrasound catheter a standard tool in many interventional procedures [2].The clinical application of intracardiac echocardiography started some years ago. In the electrophysiology, the use of ICE generates with its excellent visualization of the fossa ovalis, better imaging modality than fluoroscopy in the guidance of trans-septal punctures, especially in less experienced hands [3]. It is useful in the positioning and stabilization of the imaging ablation catheter, the evaluation of the lesion size and continuity and in the immediate identification of complications. Furthermore it improves the long-term outcome in pulmonary vein isolation with its direct visualization of microbubble formation and thereby reducing the risk of pulmonary vein stenosis [4].In congenital heart disease, ICE can be used for diagnostic purposes because of its superior image quality as compared to similar views with transesopageal echocardiography [5]. Interventions in congenital heart disease use already extendedly ICE. Especially, in the percutaneous closure of atrial septal defects, the combination with ICE allows quantitative and qualitative information for both proper ASO selection and optimal device placement [6,7]. It is associated with shorter laboratory and interventional procedure time as compared with trans-esopageal guided procedures [8]. ICE is of help in visualizing clinical complications that might occur in some procedures such as pericardial effusion, clot detection, and therapeutic device misposit...