Intracardiac echocardiography: an ideal guiding tool for device closure of interatrial communications.
BACKGROUND
This study sought to evaluate safety and radiation exposure when using intracardiac echocardiography (ICE) in comparison to transesophageal echocardiography (TEE) in order to guide transcatheter closure of interatrial communications.


METHODS
Eighty patients (44 males, 36 females, mean age 46, SD 13 years) undergoing device closure of atrial septal defect (n=12) or patent foramen ovale (n=68) had the procedure guided by ICE (n=50, group 1) or TEE (n=30, group 2). In group 1, all procedural stages were completely guided by ICE, including imaging of the interatrial communication during balloon sizing, device unfolding and release, and during the final check for adequate positioning. In group 2, exclusive implantation of devices was guided by use of TEE.


RESULTS
Especially, the spatial relationship between device and cardiac structures (e.g. the ascending aorta, the interatrial septum and the superior vena cava) was accurately demonstrated in group 1. Image resolution provided by ICE was superior to that of TEE. No severe complications, including any related to ICE, were seen. Fluoroscopy time (FT) and procedure time (PT) were shorter in group 1 than in group 2 (FT: 5.5+/-1.5 min vs. 9.3+/-1.6 min, P<0.0001; PT: 31.9+/-4.6 min vs. 38.8+/-5.8 min, P<0.01). Neither sedation nor anesthesia was required in group 1.


CONCLUSIONS
ICE is a safe tool to guide device closure of interatrial communications. For the patient, procedural stress and radiation exposure are negligible. ICE can be considered the guiding tool of choice for device closure, particularly when long or repeated echocardiographic viewing is required.
Bartel
Thomas
T
Cardiology Division, West-German Heart Center, University Clinic Essen, Hufelandstrasse 55, 45122 Essen, Germany. thomas.bartel@uni-essen.de
Konorza
Thomas
T
Neudorf
Ulrich
U
Ebralize
Tiko
T
Eggebrecht
Holger
H
Gutersohn
Achim
A
Erbel
Raimund
R
D021721:Balloon Occlusion / Q000295:instrumentation; D006328:Cardiac Catheterization; D017115:Catheter Ablation; D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005471:Fluoroscopy; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D018084:Ultrasonography, Interventional