Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: Feasibility and comparison with transesophageal echocardiography

Transesophageal echocardiography (TEE) has been employed successfully for g uiding transcatheter device closure of secundum atrial septal defect (ASD) and patent foramen ovate (PFO). However, the use of TEE for device closure requires general anesthesia. Intracardiac echocardiography (ICE) can provid e similar anatomical views that might replace the use of TEE for device clo sure. Eleven patients (eight female/three male) with secundum ASD and PFO a ssociated with strokes underwent attempts at transcatheter closure of their defects under sequential TEE and ICE guidance (six patients) and under ICE alone (five patients). The ages of the patients ranged from 6.6 to 74.7 yr , and their weights ranged from 23 to 124.5 kg. The sizes of the defects, a s measured by TEE (six patients), ranged from 3 to 27 mm and, as measured b y ICE (11 patients), from 3 to 27 mm. The balloon-stretched diameter of the ASD, as measured by TEE (six patients), ranged from 16 to 38 mm and, as me asured by ICE (11 patients), from 16 to 35 mm. Both techniques correlated w ell for the measured two-dimensional diameter and for the balloon-stretched diameter (r = 0.97 and 0.98, respectively). Both TEE and ICE provided simi lar views of the defects and the various stages of device deployment. Owing to the proximity of the left atrium to the esophagus, however, the images obtained by ICE were more helpful and informative than those obtained by TE E. All patients experienced successful device placement (six patients under both TEE and ICE; five patients under ICE guidance alone); complete closur e of the defects was effected in nine patients, whereas two patients had sm all residual shunts. There were no complications. We conclude that ICE prov ides unique images of the atrial communications and measurements similar to those obtained by TEE. ICE potentially could replace TEE as a guiding imag ing tool for ASD and PFO device closure, thus eliminating the need for gene ral anesthesia. Cathet Cardiovasc Intervent 2001;52:194-199. (C) 2001 Wiley -Liss, Inc.