The Emerging Role of Intracardiac Echocardiography -- Into the ICE Age

Andrew R.J. Mitchell; Prasanna Puwanarajah; Jonathan Timperley; Harald Becher; Neil Wilson; Oliver J. Ormerod

Disclosures

Br J Cardiol. 2007;14(1):31-36. 

In This Article

Visualisation of the Interatrial Septum

ICE is perfectly suited to the visualisation of right heart structures and provides real time imaging of cardiovascular anatomy. The current principal use of the ICE catheter is to provide images of the interatrial septum during percutaneous closure of patent foramen ovale (PFOs) and atrial septal defects (ASDs).[2,3,4] The catheter is gently advanced to the mid-right atrium from the inferior vena cava and rotated to provide the 'standard view' (figure 2). In this view the tricuspid valve can be seen directly in front of the transducer.

Figure 2.

a: The intracardiac echocardiography (ICE) catheter advanced to the mid right atrium (RA). This provides views, shown in b: of the tricuspid and aortic valves.

By gently retro-flexing the catheter tip and slowly rotating clock-wise, the atrial septum appears directly in front of the catheter tip (see figure 3). Outstanding images of the interatrial septum can then be obtained. This position is then usually extremely stable so only minute movements of the catheter are required for image optimisation during device deployment (figure 4).

Figure 3.

a: The intracardiac echocardiography (ICE) catheter retroflexed in the right atrium (RA). This provides views, shown in b: of the atrial septal defect (ASD) and the left atrium (LA).

Figure 4.

Echocardiograms showing: a: a catheter through the atrial septal defect (ASD) into the left atrium (LA); b and c: the view from the right atrium (RA) showing balloon sizing of the ASD; d: deployment of an atrial septal occluder showing expansion of the LA disc. This was followed by expansion of the RA disc and a good stable position was finally achieved across the ASD.

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