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Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions

  • Echocardiography (JM Gardin and AH Waller, Section Editors)
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Abstract

Purpose of Review

With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions.

Recent Findings

Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures.

Summary

This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.

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Abbreviations

ASD:

Atrial septal defect

CMC:

Circular marking catheter

ICE:

Intracardiac echocardiography

IPAI:

Intraluminal phased-array imaging

LAA:

left atrial appendage

PDA:

Patent Ductus Arteriousus

PMBV:

percutaneous mitral balloon valvuloplasty

PMVR:

percutaneous mitral valve repair

PVL:

paravalvular leak

tPVR:

transcatheter pulmonary valve replacement

RT-3D:

Real-time three dimensional

TAVI:

Transaortic valve implantation

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

TS:

Transseptal

VSD:

Ventricular Septal Defect

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  1. Department of Cardiovascular Medicine, Lenox Hill Hospital – Northwell Health, New York, NY, USA

    Craig Basman, Yuvrajsinh J. Parmar & Itzhak Kronzon

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  1. Craig Basman
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Craig Basman, Yuvrajsinh J. Parmar, and Itzhak Kronzon declare that they have no conflict of interest.

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Basman, C., Parmar, Y.J. & Kronzon, I. Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions. Curr Cardiol Rep 19, 102 (2017). https://doi.org/10.1007/s11886-017-0902-6

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