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STATE-OF-THE-ART PAPER

The Use of Intracardiac Echocardiography and Other Intracardiac Imaging Tools to Guide Noncoronary Cardiac Interventions

Susan S. Kim, MD^_*, Ziyad M. Hijazi, MD, Roberto M. Lang, MD^_* and Bradley P. Knight, MD^_*,_*

^_* Division of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois
Rush Center for Congenital and Structural Heart Disease, Rush University, Chicago, Illinois

Manuscript received September 12, 2008; revised manuscript received January 6, 2009, accepted January 19, 2009.

^_* Reprint requests and correspondence: Dr. Bradley P. Knight, University of Chicago Hospitals, Center for Advance Medicine, MC 9024, 5758 South Maryland Avenue, Chicago, Illinois 60637 (Email: bknight{at}medicine.bsd.uchicago.edu).

The limitations of standard fluoroscopy have led to the development of improved imaging techniques to guide noncoronary cardiac interventions. Imaging tools that are used in the interventional laboratory can be categorized as invasive and noninvasive. Noninvasive cardiac imaging tools include ultrasound, computed tomography, and magnetic resonance imaging. These modalities can generate high-resolution images of the heart and are increasingly being used to guide cardiac interventions. Despite these advances, there remains a strong role for invasive imaging tools in the interventional laboratories. Such invasive imaging tools include transesophageal echocardiography, intracardiac echocardiography, intracardiac endoscopy, and electroanatomic mapping systems. Despite the risks inherent to the invasive nature of these tools, these modalities can provide excellent real-time, detailed images that can be invaluable in guiding certain cardiac interventions. This review will propose the features of an ideal intracardiac imaging tool, summarize the intracardiac imaging tools that are currently available or under development to guide noncoronary cardiac interventional procedures, and suggest opportunities for improvement. One opportunity in this field is to couple imaging systems directly with the interventional devices themselves. The use of intracardiac imaging to guide select cardiac procedures including transseptal catheterization, catheter ablation procedures for arrhythmias, and percutaneous placement of cardiac valves and closure devices will also be discussed. Most of this review will be devoted to intracardiac echocardiography, which currently has the broadest number of applications.

Key Words: imaging • intracardiac • interventional

Abbreviations and Acronyms   AF = atrial fibrillation   ASD = atrial septal defect   CS = coronary sinus   CT = computed tomography   FO = fossa ovalis   ICE = intracardiac echocardiography   LA = left atrium/atrial   LAA = left atrial appendage   MRI = magnetic resonance imaging   PFO = patent foramen ovale   PV = pulmonary vein   RA = right atrium/atrial   RF = radiofrequency   TEE = transesophageal echocardiography   TSP = transseptal puncture   TTE = transthoracic echocardiography   3D = 3-dimensional

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J. Am. Coll. Cardiol. 2009 53: A24. [Full Text] [PDF]