The Use of Intracardiac Echocardiography During Percutaneous Pulmonary Valve Replacement

Abstract

High-quality live imaging assessment of cardiac valves and cardiac anatomy is crucial for the success of catheter-based procedures. We present our experience using Intracardiac echocardiography (ICE) during transcatheter Percutaneous Pulmonary Valve replacement (tPVR).This is a retrospective study that included 35 patients who underwent tPVR between April 2008 and June 2012. Thirty-one of these patients had the procedure performed under continuous ICE guidance. Pre-procedure transthoracic echocardiography (TTE) was obtained in all patients. ICE was performed at baseline, during the procedure, and at the conclusion of the procedure. Comparisons between the pre-procedure TTE and baseline ICE data and between post-procedure ICE data and the following day TTE were performed. Total of 35 patients had tPVR during the above-mentioned time period. Twenty-one patients received the Edwards Sapien valve and 14 patients had the Melody valve. Thirty-one patients had the procedure performed under continuous ICE guidance. The mean Pre-TTE peak gradient (PG) and Pre-ICE-PG were 45.5 ± 20 vs 33 ± 13 mmHg (p < 0.001) and the mean Pre-TTE mean gradient (MG) and Pre-ICE-MG were 27.7 ± 13 vs 21 ± 18 mmHg (p < 0.001). The mean Post-TTE- PG and Post-ICE-PG were 24.3 ± 11 vs 15.3 ± 7 mmHg (p < 0.001) and the mean of the Post-TTE-MG and Post-ICE-MG were 14.2 ± 7 vs 8.4 ± 4 mmHg (p < 0.001). There was a good correlation between peak ICE and TTE gradient at baseline and after valve placement. For the degree of pulmonary regurgitation, there was no significant difference between TTE and ICE. ICE is an important modality to guide tPVR in patients with dysfunctional homograft valve between the right ventricle and pulmonary artery and should be used to assess valve function before, during and immediately after the procedure.

The Utility of Intracardiac Echocardiography Following Melody™ Transcatheter Pulmonary Valve Implantation

“…Awad et al [3] recently reported on their experience with 31 patients who underwent TPV replacement with either a Melody or Edwards Sapien TPV with continuous ICE monitoring. The authors concluded that ICE was an important modality to guide valve implantation, due to the ability to continuously monitor the newly implanted valve gradients and to provide accurate assessment of valve function in the absence of indwelling catheters.…”

“…Obtaining additional information with ICE that may be difficult to evaluate by angiography, such as the presence of paravalvar leak, may also allow the interventionalist to address these issues immediately during the same procedure and prevent subsequent procedures. The use of ICE in Melody TPV implantation has been reported in isolated case report and case series [6,7], and, most recently, Awad et al [3] reported on the use of continuous ICE guidance during implantation of both the Melody and Edwards Sapien (Edwards Lifesciences, Irvine, CA) TPV. While anatomic and functional assessment of the pulmonary valve can be obtained easily by ICE [11,12], a comprehensive analysis of clinical utility in this population is lacking.…”

Trans‐pulmonary echocardiography as a guide for device closure of patent ductus arteriosus

“…One of the drawbacks of TPE might be the requirement of another sheath in femoral vein and the size of echo catheter. However, ICE has been already applied to many other types of catheter interventions . Also ICE has been applied to guide closure of atrial septal defect even in small children less than 15 kg of body weight .…”

“…Overcoming this disadvantage of TEE, intra‐cardiac echocardiography (ICE), especially using AcuNav™ (Biosense Webster Inc, Diamond Bar, CA, USA), has been developed and widely used in catheter intervention for inter‐atrial septum, closure of atrial septal defect or perforation of inter‐atrial septum, with local anesthesia . Recently ICE catheter has expanded its application and was used in the other types of catheter interventions including percutaneous pulmonary or aortic valve replacement and balloon valvuloplasty . However, there is no report of the ICE catheter used in the pulmonary artery to guide DC‐PDA.…”

Bacterial Endocarditis Manifesting as Outflow Tract Obstruction in Two Patients Implanted With Percutaneous Prosthetic Pulmonary Valves

“…Transesophageal echocardiography is less helpful for this purpose (especially when the bioprosthesis is seated inside an anteriorly positioned conduit), and intracardiac echocardiography can prove to be especially helpful. 3 Nonsurgical transcatheter-based relief of the outflow obstruction can serve either as a destination therapy (if a new valve is deployed) or as a bridge to surgery (if a stent is deployed) until more favorable hemodynamic conditions are achieved. Potential complications, including those described in this report, should be kept in mind.…”