Multiplane/3D transesophageal echocardiography monitoring to improve the safety and outcome of complex transvenous lead extractions

Abstract

Both transesophageal echocardiography (TEE) and intracardiac echocardiography have been used to assist transvenous lead extractions. The clinical utility of continuous echocardiographic monitoring during the procedure is still debated, with different reports supporting opposite findings. In cases where the procedure is expected to be difficult, we propose adding a continuous TEE monitoring using a static 3D/multiplane probe in mid‐esophageal position, with digital remote manipulation of the field of view. This approach may improve the chances of a successful extraction, increase safety, or even guide the entire intervention. We present here a short case series where continuous monitoring by TEE played an important role.

Transesophageal echocardiography for the monitoring of transvenous lead extraction

“…Hemodynamic instability requires urgent verification of its causes, and first of all ruling out heart injury, bleeding and tamponade. Inversion of the RV visible on 2D TEE may also be confirmed on 3D imaging and the cause of pressure fall can be quickly identified [1,2,[11][12][13]16,23,29].…”

“…Assessment of the dynamics of bleeding helps the operator make an extremely important decision whether a chest drain is required, or whether it is enough to monitor the patient if the bleeding stops. In an emergency situation usually there is no time for inserting an esophageal probe and starting diagnostic imaging [12][13][14][15][16][17][18].…”

“…TEE was found helpful in distinguishing free-floating from adherent leads. Furthermore, 3D TEE allowed for more precise detection of the course of the leads and the relationship between the lead and the tricuspid valve (leaflets, commissures, tendinous ring) [16,32] (Fig.1 S-supplementary file).…”

“…Another important advantage of 2D and 3D TEE in patients undergoing TLE is a possibility of visualizing and monitoring percutaneous removal of silicone tube remnants left in cardiac cavities after TLE [16]. Insulation fragments remaining lodged in cardiac cavities are rarely described in the literature [18,27,31].…”

A new approach to the continuous monitoring of transvenous lead extraction using transesophageal echocardiography—Analysis of 936 procedures

“…Another extremely important aspect of TEE monitoring during transvenous lead extraction is visualization of the tricuspid valve and assessment of its function. According to the available reports the incidence of significant injury to the tricuspid valve during the TLE procedure ranges from 5% to 13% and is considered a major complication of lead extraction.…”