Utility of Transesophageal Echocardiography for Transcatheter Occlusion of Patent Ductus Arteriosus in Dogs: Influence on the Decision-Making Process

Abstract

Background: Appropriate device selection for transcatheter occlusion of patent ductus arteriosus (PDA) is essential to procedural success.Objectives: To determine if transesophageal echocardiography (TEE) influences device selection for PDA occlusion and to report benefits, limitations, and complications associated with TEE.Animals: Twenty-two client-owned dogs with left-to-right shunting PDA. Methods: PDA dimensions were obtained via transthoracic echocardiography (TTE) and then TEE followed by angiography. Based solely on information from TTE and angiography, an initial device type and size were selected. After initial device selection, TEE measurements were disclosed and changes in device selection were recorded. After device release, angiography, TEE, or both were performed to assess occlusion.Results: An Amplatz canine duct occluder (ACDO) was securely positioned and released in 21 dogs and an embolization coil was deployed in 1 dog. Based on TEE evaluation, initial selected device type was unchanged but ACDO size was changed in 3 dogs. TEE was utilized throughout the procedure allowing real time visualization of device deployment, release and assessment of closure in 17 dogs. No complications occurred related to TEE. Complete PDA closure was achieved in all dogs.Conclusions and Clinical Importance: TEE provided anatomic information regarding PDA morphology that closely approximated angiographic ductal dimensions while aiding in device deployment, release and confirmation of closure. We conclude that TEE provides complementary anatomical and intraprocedural information and is well tolerated in dogs.

Transthoracic echocardiographically-guided interventional cardiac procedures in the dog

“…To reduce radiation exposure and achieve better visualization of the patent ductus arteriosus (PDA) during transcatheter coil embolization, transesophageal echocardiography (TEE) has been used to guide the procedure in a dog 1 and for deployment of Amplatz Ò Canine Ductal Occluder f (ACDO) in a series of dogs. 2 Transesophageal echocardiographic guidance reduces potentially fluoroscopic radiation exposure and the number of contrast injections, 2 but is also limited by cost and availability. Transthoracic echocardiography (TTE) allows the imaging of cardiac chambers as well as great vessels.…”

Veterinary Applications of the Tridimensional Echocardiography

“…Over the last 20 years the technological evolution of 2D TEE has improved the assessment of certain congenital cardiomyopathies [50][51][52][53] and the monitoring of percutaneous interventions [24][25][26][27]. The quality of the echocardiographic images is often better than those obtained by transthoracic echocardiography because of the high resolution of the transducers, the proximity of the structures being studied, and the reduction in interference from other structures [51].…”

Echocardiographic Evaluation of Congenital Cardiopathies Before and After Intervention

“…A multiplane TEE can also help to determine whether the PDA ostium is elliptic rather than circular (short axis view), which can affect the selection of the occlusion device. Finally, TEE is useful for monitoring the occlusion procedure [49]. This technique allows real-time observation of the occlusion device deployment within the PDA ( Figure 20-10) as well as evaluation of the flow through the PDA before and after placement of the occlusion device ( Figure 20-11).…”