Author + information
- Received August 9, 2018
- Accepted August 21, 2018
- Published online November 5, 2018.
- Sergio Berti, MD∗ (, )
- Luigi Emilio Pastormerlo, MD,
- Simona Celi, MSE,
- Marcello Ravani, MD,
- Giuseppe Trianni, MD,
- Elisa Cerone, BSc and
- Gennaro Santoro, MD
- ↵∗Address for correspondence:
Dr. Sergio Berti, Department of Interventional and Diagnostic Cardiology, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, 54100 Massa, Italy.
- atrial fibrillation
- cardiovascular imaging
- ICE real-time 3D/4D
- intracardiac echocardiography
- left atrial appendage closure
Transesophageal echocardiography is the most commonly used imaging modality for percutaneous closure of left atrial appendage limited mainly by the need for general anesthesia. Intracardiac echocardiography (ICE) requires only local anesthesia, but imaging quality may be suboptimal. Real-time 3-dimensional (RT3D) ICE, now available, may overcome these limitations (1,2). We report the first ever use of RT3D ICE to guide the closure of left atrial appendage in an 85-year-old man referred because of absolute contraindication to oral anticoagulant agents. We used an Acuson AcuNav 3D 10-F ultrasound catheter capable of acquiring a 90° x 24° real-time volume imaging.
In the RT3D ICE–guided procedure, the probe was positioned in the right atrium for transseptal puncture (Figure 1, Online Video 1). On the basis of computed tomographic findings, a 25-mm Amplatzer Cardiac Plug II (Abbott Vascular, Canta Clara, California) was selected (Figure 2, Online Video 2). RT3D ICE was used to guide lobe delivery, device stability test, and definitive release (Figures 3 and 4⇓⇓). The 3-dimensional view highlights the relation between the device and surrounding structures (Figure 5, Online Video 3).
As shown, RT3D ICE permits a more comprehensive anatomic assessment with immediate detailed feedback of intracardiac structures during complex procedures such as closure of left atrial appendage.
Dr. Berti is a proctor for Abbott and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 9, 2018.
- Accepted August 21, 2018.
- 2018 American College of Cardiology Foundation