Initial clinical experience with intracardiac echocardiography in guiding transcatheter closure of perimembranous ventricular septal defects: Feasibility and comparison with transesophageal echocardiography

Qi Ling Cao, Carlos Zabal, Peter Koenig, Satinder K Sandhu, Ziyad M. Hijazi

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Over the last several years, intracardiac echocardiography (ICE) has been employed successfully in guiding transcatheter device closure of a secundum atrial septal defect (ASD) or patent foramen ovale (PFO). Nothing is known regarding the use of ICE to guide catheter device closure of a perimembranous ventricular septal defect (PMVSD). Twelve patients (seven female/five male) who had a PMVSD (among them, three patients with associated atrial communications: two with an ASD and one with a PFO) underwent attempts at transcatheter device closure using the Amplatzer membranous VSD device of their defects, using sequential transesophageal echocardiography (TEE) and ICE guidance with general endotracheal anesthesia (five patients) and using ICE alone with conscious sedation (seven patients). The mean age of patients was 16.9 ± 3.7, and their mean weight was 42.4 ±6.6. Their mean left ventricular end-diastolic dimension preclosure was 45.7 ± 2.5. The Qp/Qs ratio ranged from 1.0 to 1.8:1. During the procedure, the ICE catheter was positioned in the right atrium (RA) in all 12 patients and the ICE catheter was advanced to the left atrium to obtain a view of the ventricular septum in 3. Both TEE and ICE provided similar anatomical views of the position of the PMVSD. Furthermore, the relationship of the defect to the aortic valve and tricuspid valves, the measured size of defect, and the guidance of various stages of device deployment were comparable by TEE and ICE. There were no complications encountered during or after closure. We conclude that ICE provides unique images of the PMVSD and measurements similar to those obtained by TEE. ICE potentially could replace TEE in most patients as a guiding imaging tool for PMVSD device closure, thus eliminating the need for general endotracheal anesthesia.

Original languageEnglish
Pages (from-to)258-267
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume66
Issue number2
DOIs
StatePublished - Oct 1 2005
Externally publishedYes

Fingerprint

Ventricular Heart Septal Defects
Transesophageal Echocardiography
Echocardiography
Equipment and Supplies
Endotracheal Anesthesia
Cardiac Catheters
Patent Foramen Ovale
Atrial Heart Septal Defects
Heart Atria
General Anesthesia
Conscious Sedation
Ventricular Septum
Tricuspid Valve
Aortic Valve
Catheters
Communication
Weights and Measures

Keywords

  • Intracardiac echocardiography
  • Perimembranous ventricular septal defect
  • Transcatheter device closure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Initial clinical experience with intracardiac echocardiography in guiding transcatheter closure of perimembranous ventricular septal defects: Feasibility and comparison with transesophageal echocardiography",
abstract = "Over the last several years, intracardiac echocardiography (ICE) has been employed successfully in guiding transcatheter device closure of a secundum atrial septal defect (ASD) or patent foramen ovale (PFO). Nothing is known regarding the use of ICE to guide catheter device closure of a perimembranous ventricular septal defect (PMVSD). Twelve patients (seven female/five male) who had a PMVSD (among them, three patients with associated atrial communications: two with an ASD and one with a PFO) underwent attempts at transcatheter device closure using the Amplatzer membranous VSD device of their defects, using sequential transesophageal echocardiography (TEE) and ICE guidance with general endotracheal anesthesia (five patients) and using ICE alone with conscious sedation (seven patients). The mean age of patients was 16.9 ± 3.7, and their mean weight was 42.4 ±6.6. Their mean left ventricular end-diastolic dimension preclosure was 45.7 ± 2.5. The Qp/Qs ratio ranged from 1.0 to 1.8:1. During the procedure, the ICE catheter was positioned in the right atrium (RA) in all 12 patients and the ICE catheter was advanced to the left atrium to obtain a view of the ventricular septum in 3. Both TEE and ICE provided similar anatomical views of the position of the PMVSD. Furthermore, the relationship of the defect to the aortic valve and tricuspid valves, the measured size of defect, and the guidance of various stages of device deployment were comparable by TEE and ICE. There were no complications encountered during or after closure. We conclude that ICE provides unique images of the PMVSD and measurements similar to those obtained by TEE. ICE potentially could replace TEE in most patients as a guiding imaging tool for PMVSD device closure, thus eliminating the need for general endotracheal anesthesia.",
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T1 - Initial clinical experience with intracardiac echocardiography in guiding transcatheter closure of perimembranous ventricular septal defects

T2 - Feasibility and comparison with transesophageal echocardiography

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AU - Koenig, Peter

AU - Sandhu, Satinder K

AU - Hijazi, Ziyad M.

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