Intracardiac Echocardiography: Procedural Steps and Clinical Application

Intracardiac Echocardiography: Procedural Steps and Clinical Application

Rajesh K. Nair (Rigshospitalet, Denmark), Poay Huan Loh (Rigshospitalet, Denmark) and Lars Sondergaard (Rigshospitalet, Denmark)
DOI: 10.4018/978-1-61350-095-8.ch015
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Intracardiac echocardiography (ICE) represents one of the major recent advancements in cardiovascular imaging that has directly widened the scope of structural heart disease intervention. It has replaced trans-esophageal echocardiography in many of the structural heart disease interventional procedures and hence, precluded the need for general anaesthetic and its associated clinical and logistic issues. Although ICE has been available for more than two decades, it is still not widely used, and many interventional cardiologists remain unfamiliar to this technology. It is the aim of this chapter to provide a comprehensive overview of the commercially available devices with specific reference to the AcuNav™ catheter (Biosense Webster, California, USA), the procedural steps, and clinical applications of this imaging technique.
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Parts of the Equipment and Procedure

The AcuNav™ catheter incorporates 64-element vector phased-array transducer (5.5-10MHz) with full spectral, colour and tissue Doppler capabilities. (Bartel, Caspari, Mueller, & Erbel, 2002) The transducer scans in a longitudinal plane with respect to the catheter providing a 90° sector image. The AcuNav™ catheter is for single use and can be attached to a standard ultrasound machines using adaptors. The catheter is available at 10F and 8F sizes, which are introduced via 11F and 9F sheaths respectively. The depth of ultra sound tissue penetration is up to 12cm for the 10F catheter and 16cm for the 8F catheter. This allows effective visualization of left sided heart structures from the right heart chambers. As there are no guide wires, the catheters should be carefully manipulated under fluoroscopy using 2 proximal rings. (Figure 1) Bi-plane fluoroscopy complements maneuvering of ICE catheter through tortuous iliac vessels or in complex cardiac anatomy with the radio-opaque transducer at the catheter tip as guide. Once inside the vascular system, the distal catheter tip may be articulated to 4 directions (anterior, posterior, left and right) using 2 proximal rings for optimal imaging. (Figure 1) The handle also has a ‘locking knob’ allowing the tip of the catheter to be ‘locked’ in order to maintain a desired plane and to provide ‘hands-free’ imaging. With experience, the catheter can be advanced with tip deflectability without fluoroscopy within the RA, through the tricuspid valve or even through a patent foramen ovale into LA. Different imaging planes are described below for optimal imaging of various cardiac structures with ICE.

Figure 1.

AcuNav™ ICE catheter - note the three control rings at the handle, the most proximal one the ‘locking knob’ which locks the tip direction, the middle ring controls the left / right direction and the distal ring controls the anterior / posterior movement of the tip.

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