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Safety and efficacy of transcatheter closure of atrial septal defect type II under transthoracic echocardiographic guidance: A case control study. J Saudi Heart Assoc 2018; 31:2-8. [PMID: 30337795 PMCID: PMC6187049 DOI: 10.1016/j.jsha.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/28/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background Transcatheter closure of secundum atrial septal defect is routinely performed under general anesthesia and transesophageal echocardiography guidance. If patients have good echo windows, the procedure could be performed under transthoracic echo guidance. Aim of study To evaluate safety and efficacy of the intervention using fluoroscopy and echo guidance. Methods In a case control study design, 180 patients underwent atrial septal defect closure between January 2010 and December 2016. In 32 patients, the intervention was performed under fluoroscopy and transthoracic echo guidance. Our study group consisted of 22 out of 32 patients (<13 years old). For the other 10 patients, we could not find a matching pair. The data of the study group were compared with an age, weight, and height matched group (controls), who underwent the procedure under transesophageal echocardiography guidance. Results The diameter of the atrial septal defect, septal length, and most of the rims were comparable. The superior rim and inferior rims were longer in the study group. The devices chosen for the cases were larger than the control group. Procedure time and fluoroscopy times were shorter in the study group. Success rate was comparable. On follow-up, both groups had almost no or minimal incidence of residual shunt. Conclusion We conclude that transcatheter closure of atrial septal defect under fluoroscopy and transthoracic echo guidance is safe and successful in selected patients who have single central atrial septal defect with adequate septal lengths and adequate septal rims, with high incidence of complete occlusion rate.
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Casella M, Dello Russo A, Vettor G, Lumia G, Catto V, Sommariva E, Ribatti V, Biagioli V, Tundo F, Carbucicchio C, Di Biase L, Natale A, Tondo C. Electroanatomical mapping systems and intracardiac echo integration for guided endomyocardial biopsy. Expert Rev Med Devices 2017; 14:609-619. [PMID: 28678556 DOI: 10.1080/17434440.2017.1351875] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION During the past years, endomyocardial biopsy (EMB) has gradually spread into clinical practice. However, the role of EMB in the diagnosis and treatment of cardiovascular diseases remains a controversial issue, especially in the setting of unexplained ventricular arrhythmias. Areas covered: This review describes the methodology of EMB guided by combined use of three-dimensional electroanatomical mapping systems and intracardiac echo and summarizes the classical, fluoroscopy-guided EMB technique. Finally, the personal experience acquired with the 'electrophysiologist-made' integration methodology has been reported. Expert commentary: Since EMB has been considered in the setting of arrhythmogenic cardiomyopathy, myocarditis, cardiac sarcoidosis, drug toxicity, and/or other diseases causing malignant ventricular arrhythmias, the electrophysiologists have started to perform firsthand biopsy. The electrophysiologists introduced the use of electroanatomical mapping systems and intracardiac echo. This new methodology improved significantly biopsy diagnostic yield and allowed to reduce complications.
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Affiliation(s)
- Michela Casella
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Antonio Dello Russo
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Giulia Vettor
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Giuseppe Lumia
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Valentina Catto
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Elena Sommariva
- b Vascular Biology and Regenerative Medicine Unit , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Valentina Ribatti
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Viviana Biagioli
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Fabrizio Tundo
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Corrado Carbucicchio
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - Luigi Di Biase
- c Texas Cardiac Arrhythmia Institute at St David's Medical Center , Austin , TX , USA.,d Albert Einstein College of Medicine at Montefiore Hospital , New York , NY , USA.,e Department of Cardiology , University of Foggia , Foggia , Italy.,f Department of Biomedical Engineering , University of Texas , Austin , TX , USA
| | - Andrea Natale
- c Texas Cardiac Arrhythmia Institute at St David's Medical Center , Austin , TX , USA.,f Department of Biomedical Engineering , University of Texas , Austin , TX , USA.,g Division of Cardiology , Stanford University , Palo Alto , CA , USA.,h Case Western Reserve University , Cleveland , OH , USA
| | - Claudio Tondo
- a Cardiac Arrhythmia Research Centre , Centro Cardiologico Monzino IRCCS , Milan , Italy
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Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, Lang RM, Rome JJ, Wang Y. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 2016; 28:910-58. [PMID: 26239900 DOI: 10.1016/j.echo.2015.05.015] [Citation(s) in RCA: 330] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Frank E Silvestry
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Laurie B Armsby
- Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, Oregon
| | | | - Craig E Fleishman
- Arnold Palmer Hospital for Children, University of Central Florida College of Medicine, Orlando, Florida
| | | | - Roberto M Lang
- University of Chicago Hospital, University of Chicago School of Medicine, Chicago, Illinois
| | - Jonathan J Rome
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yan Wang
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
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BAYKAN ALI, PAMUKCU OZGE, OZYURT ABDULLAH, ARGUN MUSTAFA, ONAN SERTACHANDEDAN, SEZER SADETTIN, UZUM KAZIM, NARIN NAZMI. Is it Safe to Close ASD with the Guidance of Transthoraxic Echocardiography in Pediatric Population “Ten Years' Experience of a Single Center”. J Interv Cardiol 2015; 28:172-9. [DOI: 10.1111/joic.12197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- ALI BAYKAN
- Division of Pediatric Cardiology; Erciyes University School Of Medicine; Kayseri Turkey
| | - OZGE PAMUKCU
- Division of Pediatric Cardiology; Erciyes University School Of Medicine; Kayseri Turkey
| | - ABDULLAH OZYURT
- Division of Pediatric Cardiology; Erciyes University School Of Medicine; Kayseri Turkey
| | - MUSTAFA ARGUN
- Division of Pediatric Cardiology; Erciyes University School Of Medicine; Kayseri Turkey
| | - SERTAC HANDEDAN ONAN
- Division of Pediatric Cardiology; Erciyes University School Of Medicine; Kayseri Turkey
| | - SADETTIN SEZER
- Division of Pediatric Cardiology; Erciyes University School Of Medicine; Kayseri Turkey
| | - KAZIM UZUM
- Division of Pediatric Cardiology; Erciyes University School Of Medicine; Kayseri Turkey
| | - NAZMI NARIN
- Division of Pediatric Cardiology; Erciyes University School Of Medicine; Kayseri Turkey
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Park KI, Kim MJ, Oh JK, Lee JH, Park JH, Choi SW, Jeong JO, Seong IW. Intracardiac echocardiography to guide biopsy for two cases of intracardiac masses. Korean Circ J 2015; 45:165-8. [PMID: 25810740 PMCID: PMC4372984 DOI: 10.4070/kcj.2015.45.2.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/18/2014] [Accepted: 07/22/2014] [Indexed: 11/11/2022] Open
Abstract
Pathologic diagnosis of a cardiac mass is vital in determining the proper treatment modality. Open heart surgery or transesophageal echocardiography guided biopsy can be feasible methods to confirm the pathology. However, the former is highly invasive and both methods require general anesthesia. The introduction of intracardiac echocardiography (ICE) can provide good anatomic information of heart and does not require general anesthesia. In this report, we present two cases of cardiac tumors which were confirmed by percutaneous biopsy under the guidance of an ICE. The patients underwent cardiac biopsy without any complications.
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Affiliation(s)
- Kwang-In Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Mi Joo Kim
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Kyung Oh
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - In-Whan Seong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Awad SM, Masood SA, Gonzalez I, Cao QL, Abdulla RI, Heitschmidt MG, Hijazi ZM. The use of intracardiac echocardiography during percutaneous pulmonary valve replacement. Pediatr Cardiol 2015; 36:76-83. [PMID: 25070389 DOI: 10.1007/s00246-014-0967-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/11/2014] [Indexed: 11/30/2022]
Abstract
High-quality live imaging assessment of cardiac valves and cardiac anatomy is crucial for the success of catheter-based procedures. We present our experience using Intracardiac echocardiography (ICE) during transcatheter Percutaneous Pulmonary Valve replacement (tPVR).This is a retrospective study that included 35 patients who underwent tPVR between April 2008 and June 2012. Thirty-one of these patients had the procedure performed under continuous ICE guidance. Pre-procedure transthoracic echocardiography (TTE) was obtained in all patients. ICE was performed at baseline, during the procedure, and at the conclusion of the procedure. Comparisons between the pre-procedure TTE and baseline ICE data and between post-procedure ICE data and the following day TTE were performed. Total of 35 patients had tPVR during the above-mentioned time period. Twenty-one patients received the Edwards Sapien valve and 14 patients had the Melody valve. Thirty-one patients had the procedure performed under continuous ICE guidance. The mean Pre-TTE peak gradient (PG) and Pre-ICE-PG were 45.5 ± 20 vs 33 ± 13 mmHg (p < 0.001) and the mean Pre-TTE mean gradient (MG) and Pre-ICE-MG were 27.7 ± 13 vs 21 ± 18 mmHg (p < 0.001). The mean Post-TTE- PG and Post-ICE-PG were 24.3 ± 11 vs 15.3 ± 7 mmHg (p < 0.001) and the mean of the Post-TTE-MG and Post-ICE-MG were 14.2 ± 7 vs 8.4 ± 4 mmHg (p < 0.001). There was a good correlation between peak ICE and TTE gradient at baseline and after valve placement. For the degree of pulmonary regurgitation, there was no significant difference between TTE and ICE. ICE is an important modality to guide tPVR in patients with dysfunctional homograft valve between the right ventricle and pulmonary artery and should be used to assess valve function before, during and immediately after the procedure.
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Affiliation(s)
- Sawsan M Awad
- Rush Centre for Congenital and Structural Heart Disease, Rush University Medical Centre, Chicago, IL, 60612, USA,
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George JC, Varghese V, Mogtader A. Intracardiac echocardiography: evolving use in interventional cardiology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:387-395. [PMID: 24567449 DOI: 10.7863/ultra.33.3.387] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intracardiac echocardiography (ICE) uses a catheter-based steerable ultrasound probe that is passed into the right heart chambers to image intracardiac structures. The transducer can be variably positioned for optimal imaging: in the inferior vena cava to visualize the abdominal aorta; in the right atrium for the interatrial septum, aortic, mitral, and tricuspid valves, and pulmonary veins; or in the right ventricle for the left ventricular function, outflow tract, or pulmonary artery. Intracardiac echocardiography is primarily used for imaging during an invasive cardiac procedure using conscious sedation, when transthoracic image quality would likely be inadequate, and transesophageal imaging would require general anesthesia. Intracardiac echocardiography is generally well tolerated and provides adequate images and sufficient information for the procedure performed. In the cardiac catheterization laboratory, ICE is routinely used for patent foramen ovale, atrial septal defect, and ventricular septal defect closures, allowing adequate percutaneous placement of septal occluders. It is now being considered in the current era of transcatheter aortic valve implantation necessitating improved imaging approaches for accurate placement. It is also routinely used for trans-septal punctures during mitral valvuloplasty and, more recently, with the advent of left atrial appendage closure devices. This article provides a comprehensive review of the current technology for ICE and its growing applications in the realm of interventional cardiology.
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Affiliation(s)
- Jon C George
- Cardiac Catheterization Laboratory, Deborah Heart and Lung Center, 200 Trenton Rd, Browns Mills, NJ 08015 USA.
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Erdem A, Sarıtas T, Zeybek C, Yucel IK, Erol N, Demır H, Odemıs E, Yalcın Y, Celebı A. Transthoracic echocardiographic guidance during transcatheter closure of atrial septal defects in children and adults. Int J Cardiovasc Imaging 2011; 29:53-61. [PMID: 21833775 DOI: 10.1007/s10554-011-9933-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 07/29/2011] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to evaluate the safety and efficacy of transcatheter atrial septal defect (ASD) closure guided by transthoracic echocardiography (TTE). Since 2004, ASD closure was performed successfully in total 337 patients. Transthoracic echocardiography guidance was used in 206 patients (61.1%) (group 1). Closure was guided by transesophageal echocardiography under general anesthesia in patients with poor transthoracic acoustic windows, defects with aneurysmatic septum and/or multiple defects in 131 patients (38.9%) (group 2). The median age (9 vs. 16 years, P < 0.001), mean defect diameter (14.9 ± 4 vs. 17.2 ± 5 mm, P < 0.001), ratio of complex atrial septal defect (14 vs. 34%, P = 0.01), the median balloon stretch dimensions (21 vs. 18.7 mm, P = 0.003) and the median device diameters (22 vs. 19 mm, P < 0.001) were significantly greater in group 2 compared to group 1. Both the median procedure time and the median fluoroscopy time was significantly shorter in group 1 (60 vs. 75; and 13 vs. 16.5 min; P < 0.0001 and P < 0.0001, respectively). The incidence of residual shunt did not differ significantly in two groups during follow up. Transthoracic echocardiography guidance during transcatheter ASD closure is safe and effective in children and in many adults. Even complex ASDs could be closed with TTE in patients with good acoustic windows. Performing the procedure under TTE guidance significantly reduces procedure time and also provides increased patient's comfort.
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Affiliation(s)
- Abdullah Erdem
- Department of Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, 34672, Istanbul, Turkey.
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Ramakrishna H, Feinglass N, Augoustides JG. Clinical Update in Cardiac Imaging Including Echocardiography. J Cardiothorac Vasc Anesth 2010; 24:371-8. [DOI: 10.1053/j.jvca.2009.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Indexed: 01/07/2023]
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