Transesophageal Echocardiography Guided Patent Ductus Arteriosus Occlusion with a Duct Occluder

Abstract

Background: Angiography and fluoroscopy are the standard methods to guide transcatheter occlusion of patent ductus arteriosus (PDA). The use of iodinated contrast agents and radiation exposure pose risks of animals and staff.Objectives: To assess feasibility of transesophageal echocardiography (TEE) for device size selection and procedure monitoring for PDA occlusion with a duct occluder (DO) without the use of angiography.Animals: Eighty client-owned dogs with left-to-right PDA. Methods: Prospective study. Dogs with left-to-right PDA undergoing transcatheter occlusion were included. Procedures were performed without angiography and device size selection was based on TEE measurements. Procedures were monitored with simultaneous TEE and fluoroscopy and both methods were compared. Visualization of the ductus and dimensions obtained by TEE and transthoracic echocardiography (TTE) were compared.Results: Complete PDA occlusion was achieved in 79/80 cases. TEE was consistently superior to TTE for PDA visualization and the latter showed higher values for ductal dimensions when compared to the former. TEE provided adequate procedure monitoring in 73 cases (91%). Fluoroscopy exposure time (2.77 AE 1.2 minutes (mean, SD)) was lower than previously reported for the same procedure.Conclusions and Clinical Importance: TEE is a useful and efficient tool for device size selection and can be used for procedure monitoring in most cases. Fluoroscopy exposure time can be reduced and the use of contrast agents can be avoided. However, fluoroscopy is required in a minority of cases when TEE monitoring is not feasible or incomplete and should be available for this procedure.

Transesophageal Echocardiography as the Sole Guidance for Occlusion of Patent Ductus Arteriosus using a Canine Ductal Occluder in Dogs

“…Although we have shown previously that TTE can be used during transcatheter PDA occlusion with ACDO, TEE overcame the problem of inadequate image quality in a minority of dogs in which ductal morphology and ACDO positioning could not be assessed sufficiently for safe deployment . In addition, TEE permitted multiplane imaging to best characterize the anatomy and size of the PDA …”

“…Transesophageal echocardiography has proven useful in evaluating PDA morphology thereby guiding appropriate device selection, and TEE in combination with fluoroscopy, has been used to guide transcatheter coil embolization and for deployment of Amplatz Canine Ductal Occluder (ACDO) in dogs . Recently, investigators examined the combined use of TEE and fluoroscopy to guide PDA occlusion using ACDO in 80 dogs . Using 2 screens (1 each for TEE and fluoroscopic imaging) to simultaneously monitor the procedures, they found that TEE provided complete monitoring of the entire procedure in 73/80 (91%) dogs .…”

“…Recently, investigators examined the combined use of TEE and fluoroscopy to guide PDA occlusion using ACDO in 80 dogs . Using 2 screens (1 each for TEE and fluoroscopic imaging) to simultaneously monitor the procedures, they found that TEE provided complete monitoring of the entire procedure in 73/80 (91%) dogs . Furthermore, studies in humans illustrate the important role of TEE during interventional cardiovascular procedures in positioning of guide wires, catheters, and devices .…”

“…Furthermore, studies in humans illustrate the important role of TEE during interventional cardiovascular procedures in positioning of guide wires, catheters, and devices . The use of TEE reduces the duration of fluoroscopic time required to perform interventional procedures, and TEE has been used exclusively for PDA embolization in 3 preterm infants on the neonatal intensive care unit . We recently described the use of TTE as the sole means of guiding, positioning, and deploying ACDO during PDA occlusion in dogs, but noted some limitations in the appropriate visualization of the PDA in dogs with suboptimal acoustic windows .…”

Late Amplatzer device displacement after percutaneous PDA embolization: case description.

“…Typically, the standard procedure is performed under fluoroscopic guidance. However, PDA occlusion under transesophageal echocardiography guidance has also been proposed (15,20). The percutaneous procedure is usually carried out via the transarterial femoral artery approach (14); otherwise, carotid artery (13) or brachial artery (18) is recommended.…”