title: Use of intracardiac echocardiography to guide percutaneous transluminal mitral commissurotomy: A 20-patient case series.
abstract: OBJECTIVE
  To report the efficacy and safety of the use adjunctive intracardiac echocardiography (ICE) during percutaneous transluminal mitral commissurotomy (PTMC) in patients without transesophageal echocardiography (TEE).
  
  
  BACKGROUND
  Patients with mitral stenosis are at a high risk of developing a left atrial (LA) thrombus. Traditionally, TEE has been used prior to PTMC to identify the presence of LA thrombi. There have been no reports of the use of ICE to assess the LA for thrombi prior to PTMC.
  
  
  METHODS
  We retrospectively reviewed 20 patients who underwent ICE prior to PTMC. All PTMC procedures were performed via the antegrade transvenous approach using an Inoue balloon. Initially, ICE was used from the right atrium to confirm the absence of a thrombus on the left side of the septum and was subsequently used to guide the transseptal puncture. Following these procedures, the ICE was advanced into the LA through a transseptal sheath to visualize the LAA.
  
  
  RESULTS
  Visualization of the thrombus/spontaneous echo contrast was considered to be diagnostic in all cases. Seventy percent of the patients were discharged on day after the procedure. No patients required intubation during the procedure, and there were no complications that could be attributed to the use of ICE. At six months after the PTMC, the incidence of stroke was zero.
  
  
  CONCLUSIONS
  ICE-guided PTMC offers excellent visualization of the LA and the LAA with satisfactory clinical outcomes and low risk. As a part of the PTMC procedure, ICE safely provides a valid alternative to a separate TEE procedure.
authors.affiliation: Advanced Cardiac Valve Center, Department of Medicine, University of Virginia, Charlottesville, Virginia.
authors.forename: Mike
authors.initials: M
authors.lastname: Saji
authors.affiliation: Advanced Cardiac Valve Center, Department of Medicine, University of Virginia, Charlottesville, Virginia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.affiliation: Advanced Cardiac Valve Center, Department of Medicine, University of Virginia, Charlottesville, Virginia.
authors.forename: John
authors.initials: J
authors.lastname: Dent
authors.affiliation: Advanced Cardiac Valve Center, Department of Medicine, University of Virginia, Charlottesville, Virginia.
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*
keywords: ICE; PMBV; PTMC; left atrial appendage; mitral stenosis; outcome