BACKGROUND: Phased-array intracardiac echocardiography (ICE) is a unique tool for imaging the heart, and has been reported to be more useful than conventional methods in guiding interventional procedures. We report our initial experience with ICE in percutaneous transcatheter device closure of atrial septal defects (ASD) or patent foramen ovale (PFO).
METHOD: From April 2004 to August 2004, ICE was performed in 9 consecutive patients diagnosed as ASD or PFO during percutaneous device closure with Amplatzer closure device. Feasibility, procedure time, success rate, and complication rate were assessed.
RESULTS: Mean age of our subjects was 31.9 years, ranging from 6 to 57. Three of them were males. ICE was performed under general anesthesia in the first three subjects, but no further patients needed general anesthesia after that. ICE could be performed successfully in all of the patients. During each procedure, the ICE catheter was placed in the right atrium and successfully provided imaging of normal or aberrant anatomy of the atrial (interatrial septum, fossa ovalis, and appendages) structures and guided correct positioning of the closure device. The mean size of the closure device used was 25 mm (range 11–32 mm). The total procedure time was 85.6짹23.9 minutes, fluoro time 20.7짹17.3 minutes, and device deployment time 54.4짹22.2 minutes. Device closure was successful in all but one subject whose defect was too small to be penetrated. Virtually no complications associated with ICE, arrhythmic or vascular, were noted during or after any of the procedures. In one patient, intracardiac thrombus was detected by ICE on the device immediately after deployment, and follow-up ICE revealed resolution after prolonged anticoagulation for 24 hours.
CONCLUSION: ICE with Doppler and color flow imaging is a feasible and relatively safe method for monitoring and guiding percutaneous transcatheter closure of ASD or PFO.