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

Abstract

The aim of this study was to determine the utility of intracardiac echocardiography (ICE) in assessing Melody™ transcatheter pulmonary valve (TPV) function immediately following valve implantation. ICE is used increasingly in percutaneous cardiac interventions. At our center, ICE is routinely utilized to evaluate valve function following Melody TPV implantation, but the utility of this practice remains unclear. A retrospective review of all Melody valves placed in the right ventricular outflow tract from April 2010 to September 2013 was performed. The clinical utility of ICE was described, along with the relationship between ICE data and traditional hemodynamic/angiographic data. ICE was performed in 54 cases and provided excellent Melody TPV visualization with no complications. ICE did not change clinical management but did provide supplemental information in two cases. In one case, angiography showed severe catheter-related Melody insufficiency. Subsequent ICE confirmed no insufficiency and prevented the need for additional angiography. In the second case, ICE allowed characterization of the mechanism of a residual gradient. ICE did not detect any clinically significant paravalvar leaks or valvar insufficiency not seen by angiography. The peak catheterization gradient was more closely approximated by the mean ICE gradient (median difference -7.4 % between measurements) than by the peak ICE gradient (median difference 58.3 %; p < 0.0001). ICE provides excellent and safe visualization following Melody TPV implantation but did not provide new clinical information impacting management in this series. Selective use of ICE in cases with more than expected valve insufficiency or larger than expected residual gradients may streamline use while maintaining optimal clinical outcomes.

Intracardiac Echocardiography to Diagnose Bioprosthetic Pulmonary Valve Thrombosis

“…ICE has an emerging role in the imaging of cardiac structures, both for diagnosis and procedural guidance, particularly in the field of structural heart interventions. ICE has been used for left atrial appendage closure ( 4 ), transcatheter mitral valve repair ( 5 ), and transcatheter pulmonary valve implantation ( 6 ). ICE plays a particularly important role in the diagnosis of pulmonary valve endocarditis, because direct visualization of prosthetic valve leaflets is otherwise challenging ( 7 , 8 ).…”

Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications

“…Following valve implant, post implant hemodynamic data are obtained, and an angiogram is performed to evaluate for perivalvar leak and valve competence. Some have advocated for intracardiac echocardiogram imaging post implant to evaluate the implant and have a reference for the future[ 19 ]. Typically for hemostasis post procedure a figure of 8 stitch is sufficient[ 20 ].…”

Intracardiac echocardiography Chinese expert consensus

“…Therefore, ICE comes with a good application prospect in the transcatheter intervention of pulmonary valve. At present, there is still little experience in the application of ICE in pulmonary valve intervention, limited to guiding transcatheter pulmonary valve replacement (TPVR) ( 134 , 135 ). In the middle view of the right atrium, ICE can be used to evaluate tricuspid valve function and estimate right ventricular pressure (if TR is present).…”