Intracardiac echocardiography (ICE) serves as an attractive adjunct for the structural and congenital interventionalist. The experience to date has been primarily obtained utilizing the AcuNav system (Boston Scientific, San Jose, California) consisting of a 64-element phased array transducer with steerable handle and locking knob utilizing a frequency range of 5–10 MHz with a tissue penetration of around 15 cm. The catheter is available in 8 and 10 French single-use designs. As with all intraprocedural imaging modalities, there are several advantages and disadvantages to the utilization of ICE imaging for procedural guidance.
Patient A: 22-year-old female (53 kg) with a secundum ASD. ICE imaging is performed from the right atrium. Prior to ASD evaluation, mild tricuspid valve regurgitation, moderate right ventricular enlargement, and normal pulmonary venous return were documented. The defect demonstrates a 5 mm retroaortic rim and 23 mm posterior/inferior rim. The static, unstretched ASD diameter is 12 mm (AVI 9913 kb)
Patient A: Color flow Doppler echocardiography demonstrates primarily left-to-right shunting at the atrial level across the secundum ASD (AVI 7629 kb)
Patient A: Successful device closure of the secundum ASD was performed with a 30 mm GORE® CARDIOFORM® Septal Occluder device (W.L. Gore & Associates Inc., Newark, DE). The left atrial disc and right atrial disc demonstrate good apposition with all rims adequately captured (AVI 10387 kb)
Patient B: 23-year-old female (52 kg) with Ebstein’s anomaly; S/p tricuspid valve replacement with a 25 mm St. Jude Biocor Bioprosthesis (St. Jude Medical, Minneapolis, MN), now with mixed bioprosthetic valve dysfunction. The tricuspid valve prosthesis is well visualized with one leaflet completely tethered and doming in diastole and incomplete opening of the remaining leaflets causing severe stenosis and regurgitation (AVI 4689 kb)
Patient B: A 22 mm Melody® transcatheter heart valve (Medtronic, Minneapolis, MN) has been placed within the existing bioprosthesis. The valve stent is well visualized and well positioned. The valve leaflets are thin with complete coaptation (AVI 4729 kb)
Patient C: 34-year-old male (68 kg) with remote history of native pulmonary valve endocarditis; S/P PVR with a 29 mm Carpentier-Edwards Perimount Bioprosthesis (Edwards Lifesciences Corp., Irvine, CA) in 2009. A 29 mm SAPIEN 3 transcatheter heart valve (Edwards Lifesciences Corp., Irvine, CA) has been placed within the existing bioprosthesis. The SAPIEN valve is well visualized and well positioned. The valve leaflets are thin with complete coaptation (AVI 4625 kb)