Intracardiac echocardiography: an ideal guiding tool for device closure of interatrial communications

Abstract

Background This study sought to evaluate safety and radiation exposure when using intracardiac echocardiography (ICE) in comparison to transesophageal echocardiography (TEE) in order to guide transcatheter closure of interatrial communications. Methods Eighty patients (44 males, 36 females, mean age 46, SD 13 years) undergoing device closure of atrial septal defect (n Z 12) or patent foramen ovale (n Z 68) had the procedure guided by ICE (n Z 50, group 1) or TEE (n Z 30, group 2). In group 1, all procedural stages were completely guided by ICE, including imaging of the interatrial communication during balloon sizing, device unfolding and release, and during the final check for adequate positioning. In group 2, exclusive implantation of devices was guided by use of TEE. Results Especially, the spatial relationship between device and cardiac structures (e.g. the ascending aorta, the interatrial septum and the superior vena cava) was accurately demonstrated in group 1. Image resolution provided by ICE was superior to that of TEE. No severe complications, including any related to ICE, were seen. Fluoroscopy time (FT) and procedure time (PT) were shorter in group 1 than in group 2 (FT: 5.5 G 1.5 min vs. 9.3 G 1.6 min, P ! 0.0001; PT: 31.9 G 4.6 min vs. 38.8 G 5.8 min, P ! 0.01). Neither sedation nor anesthesia was required in group 1. Conclusions ICE is a safe tool to guide device closure of interatrial communications. For the patient, procedural stress and radiation exposure are negligible.

Stretched Size of Atrial Septal Defect Predicted by Intracardiac Echocardiography

“…Furthermore, ICE can provide a better view of the inferior septum which TEE cannot provide. 8,9) There are two studies comparing ICE and TEE in the literature, and both reported excellent agreement. 6,10) For the reasons mentioned above, we do not believe further randomized trials between TEE and ICE are urgently needed.…”

“…Finally, there is a higher probability that TEE will interfere with the fluoroscopy due to its larger profile and position of the esophagus. 9,15,19,20) Certainly, ICE has some drawbacks. First, it needs another vascular access which is at least 9F and via a femoral vein.…”

“…ICE has been widely accepted by interventional cardiologists as an alternative image tool to TEE. [7][8][9][10] In fact, many cardiologists prefer ICE to TEE, not only because there is no need for general anesthesia, but also its better image qualities. Furthermore, ICE can provide a better view of the inferior septum which TEE cannot provide.…”

“…Through more than a decade of development, intracardiac echocardiography (ICE) is proved to be safe, effective, and user-friendly to guide transcatheter closure of ASD without the need for general anesthesia. [6][7][8][9][10] The aim of this study was to investigate the accuracy of the predicted stretched size of ASD by ICE. …”

Cardiac air transit following venous air embolism and right ventricular air aspiration*

“…Intra-cardiac echocardiography provides a unique high quality image of the right heart cavities [9][10][11][12] and is a high resolution tool both for detecting venous air embolism and intra-cardiac air. Our previous study showed that intra-cardiac echocardiography is the most sensitive method for intra-cardiac air detection, allowing the visualisation of individual air bubbles with air detected within the right ventricle immediately after its intra atrial appearance [13].…”