CLINICAL STUDY: CARDIAC IMAGING
Intracardiac echocardiography guided device closure of atrial septal defects
Michael J. Mullen, MD, MRCP*,*,
Bryan F. Dias, MD*,
Fiona Walker, MD, MRCP*,
Samuel C. Siu, MD, SM*,
Lee N. Benson, MD, FACC and
Peter R. McLaughlin, MD, FACC*
* University of Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Canada
Division of Cardiology, The Hospital for Sick Children, Toronto, Canada
Manuscript received November 28, 2001;
revised manuscript received June 28, 2002,
accepted September 26, 2002.
* Reprint requests and correspondence: Dr. Michael J. Mullen, Consultant Cardiologist, Royal Brompton Hospital, Sydney St., London SW3 6NP, United Kingdom.
m.mullen{at}rbh.nthames.nhs.uk
OBJECTIVES: This study was designed to determine the feasibility and accuracy of intracardiac echocardiography (ICE) in guiding percutaneous closure of atrial septal defects (ASD).
BACKGROUND: Intracardiac echocardiography is a novel imaging technique that might be used to guide interventional procedures. The sensitivity and specificity of ICE, compared to standard imaging techniques, in detecting potentially adverse procedural events and guiding remedial action will be an important consideration in its use.
METHODS: In a prospective study, 24 patients underwent device closure of ASD using ICE as the primary echocardiographic imaging modality. Feasibility was expressed as proportion of cases in which complete diagnostic ICE imaging was achieved. Accuracy was expressed as the percent agreement between ICE and simultaneously performed transesophageal echocardiography (TEE).
RESULTS: High-quality ICE images were acquired in all patients, though images were limited in two patients with aneurysmal septa. Intracardiac echocardiography successfully guided closure of 24 out of 25 ASDs (96%) in 23 patients. There was close agreement between ICE and TEE in their assessment of device position and the adequacy of septal capture before device release (98%) and in identifying the presence of significant residual shunts. Intracardiac echocardiography detected all potentially adverse events, including four malpositions, and guided appropriate remedial action.
CONCLUSIONS: Intracardiac echocardiography guided device closure of secundum ASDs is feasible in the majority of patients and provides diagnostic data comparable to TEE. These data indicate that ICE may be used to guide routine closure of ASDs in adults without the need for TEE and general anesthesia.
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Abbreviations and Acronyms
| | ASD | | atrial septal defect | | ICE | | intracardiac echocardiography | | RA | | right atrium | | RV | | right ventricle | | TEE | | transoesophageal echocardiography | | TV | | tricuspid valve |
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