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Herz

, Volume 44, Issue 5, pp 445–449 | Cite as

Intracardiac echocardiography for percutaneous patent foramen ovale and atrial septal defect occlusion

  • C. Kavvouras
  • M. Vavuranakis
  • S. Vaina
  • K. Lampropoulos
  • G. BazoukisEmail author
  • G. Tse
  • D. Tousoulis
Original articles

Abstract

Background

Transesophageal echocardiography (TEE) plays a unique role in transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO). However, problems such as the need for general anesthesia, possible trauma from endotracheal intubation, presence of “blind spots,” and occasional inadequate imaging of some cardiac structures have necessitated better imaging techniques. Our study aimed to compare the findings of TEE during the initial diagnostic examination with those from intracardiac echocardiography (ICE) acquired during the interventional procedure.

Methods

A total of 65 patients in whom TEE was used for the diagnosis of ASD or PFO were included. Of these, 40 patients (61.5%) had ASD with significant left to right shunt and 25 (38.5%) patients had PFO associated with transient ischemic attack or stroke. ICE imaging was performed under local anesthesia in all patients to guide interatrial communication closure.

Results

ICE provided adequate views of the defects and surrounding structures during the various stages of device deployment. In eight patients (12.3%) an additional anatomical variation was detected. All patients had successful device implantation and were discharged 1 day after the procedure.

Conclusion

ICE is a safe and high-quality imaging technique for guiding transcatheter ASD and PFO occlusion. Additionally, ICE can both facilitate device implantation and detect cardiac abnormalities that are not identified with TEE during the initial diagnostic investigation.

Keywords

Cardiac septal defects Patent foramen ovale Intracardiac imaging techniques Transesophageal echocardiography Percutaneous coronary intervention 

Intrakardiale Echokardiographie bei perkutanem Verschluss eines offenen Foramen ovale und eines Vorhofseptumdefekts

Zusammenfassung

Hintergrund

Die transösophageale Echokardiographie (TEE) ist von besonderer Bedeutung beim kathetergestützten Verschluss eines Vorhofseptumdefekts („atrial septal defect“, ASD) oder eines offenen Foramen ovale („patent foramen ovale“, PFO). Jedoch wurden durch Probleme wie die Notwendigkeit einer Allgemeinnarkose, mögliche Verletzungen durch die endotracheale Intubation, das Vorhandensein „blinder Flecke“ und die gelegentlich unzureichende Darstellung einiger kardialer Strukturen bessere Bildgebungsverfahren erforderlich. Die vorliegende Studie zielte darauf ab, die Befunde der TEE während der diagnostischen Eingangsuntersuchung mit den Befunden der während der Intervention durchgeführten intrakardialen Echokardiographie (ICE) zu vergleichen.

Methoden

Insgesamt wurden 65 Patienten, bei denen die TEE zur Diagnosestellung eines ASD oder PFO verwendet wurden, in die Studie aufgenommen. Davon wiesen 40 Patienten (61,5%) einen ASD mit erheblichem Links-rechts-Shunt auf, bei 25 (38,5%) Patienten bestand ein PFO, das mit transienten ischämischen Attacken oder einem Schlaganfall einherging. Die ICE-Bildgebung wurde bei allen Patienten unter Lokalanästhesie durchgeführt, um den Verschluss der Verbindung zwischen den beiden Vorhöfen zu steuern.

Ergebnisse

Die ICE-Bildgebung lieferte ausreichende Ansichten der Defekte und der umgebenden Strukturen während der verschiedenen Stadien der Intervention. Bei 8 Patienten (12,3%) wurde eine zusätzliche anatomische Variante entdeckt. Bei allen Patienten war die Implantation des Systems erfolgreich, sie wurden einen Tag nach der Intervention entlassen.

Schlussfolgerung

Die ICE ist ein sicheres Bildgebungsverfahren von hoher Qualität für den kathetergestützten Verschluss eines ASD oder eines PFO.

Schlüsselwörter

Kardiale Septumdefekte Offenes Foramen ovale Intrakardiale Bildgebungsverfahren Transösophageale Echokardiographie Perkutane Koronarintervention 

Notes

Compliance with ethical guidelines

Conflict of interest

C. Kavvouras, M. Vavuranakis, S. Vaina, K. Lampropoulos, G. Bazoukis, G. Tse, and D. Tousoulis declare that they have no competing interests.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.1st Department of Cardiology, Athens Medical SchoolUniversity of Athens, “Hippokration” HospitalAthensGreece
  2. 2.Second Department of CardiologyEvangelismos General Hospital of AthensAthensGreece
  3. 3.Department of Medicine and Therapeutics, Faculty of MedicineChinese University of Hong KongHong KongChina
  4. 4.Li Ka Shing Institute of Health Sciences, Faculty of MedicineChinese University of Hong KongHong KongChina

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