Abstract
Background and Objectives: Transesophageal echocardiography (TEE) guidance is the current gold standard for catheter-based procedures in the treatment of structural heart diseases. Intracardiac echocardiography (ICE), which can be performed under local anesthesia, has been recently introduced and is becoming more widely used. We aimed to compare the efficacy and safety of ICE and TEE in patent foramen ovale (PFO) device closure. Materials and Methods: All 74 patients with a history of cryptogenic stroke undergoing PFO closure for secondary prophylaxis were selected from our registry. Intraprocedural TEE was performed by echocardiographer-cardiologists with the patient under general anesthesia. Conversely, ICE was performed with the patient under local anesthesia. Baseline characteristics, procedural details, and immediate outcomes were compared between the TEE and ICE groups (n = 49 and n = 25, respectively). Results: Although patients in the ICE group were older (47 ± 10 vs. 57 ± 7 years, p < 0.001), sex and comorbidity variables were similar between the two groups. The degree of inducible right-to-left shunt via the PFO, assessed using preprocedural TEE, was also comparable. Notably, fluoroscopy time (22 ± 18 vs. 16 ± 7 min, p = 0.030), radiation dose (498 ± 880 vs. 196 ± 111 mGy, p = 0.022), and total procedural time in the catheter laboratory (99 ± 30 vs. 67 ± 12 min, p < 0.001) were significantly lower in the ICE group than those in the TEE group. The entire hospital stay was similar between groups (3.8 ± 2.2 vs. 3.4 ± 1.3 days, p = 0.433). No procedural complications, such as device embolization, pericardial hemorrhage, major bleeding, mortality, or access-related vascular injury were reported in either group. Conclusions: ICE-guided PFO device closure is quicker and less hazardous in terms of radiation exposure than the TEE-guided procedure, with similar procedural outcomes and duration of hospital stay.
Highlights
The foramen ovale is a physiological shunt of fetal circulation and normally fuses spontaneously after birth
patent foramen ovale (PFO) device closure is usually performed under the guidance of real-time transesophageal echocardiography (TEE) with the assistance of echocardiographer-cardiologists
The recently introduced intracardiac echocardiography (ICE), which is usually performed by an interventional cardiologist, is being more widely used to guide the closure of interatrial communications because it is well tolerated by patients [8,9,10]
Summary
The foramen ovale is a physiological shunt of fetal circulation and normally fuses spontaneously after birth. PFO device closure is usually performed under the guidance of real-time transesophageal echocardiography (TEE) with the assistance of echocardiographer-cardiologists. The recently introduced intracardiac echocardiography (ICE), which is usually performed by an interventional cardiologist, is being more widely used to guide the closure of interatrial communications because it is well tolerated by patients [8,9,10]. Approximately half of the interatrial communication closures currently being performed are done under ICE guidance, no direct comparison has been reported between the conventional TEE-guided. Intracardiac echocardiography (ICE), which can be performed under local anesthesia, has been recently introduced and is becoming more widely used. We aimed to compare the efficacy and safety of ICE and TEE in patent foramen ovale (PFO) device closure. ICE was performed with the patient under local anesthesia
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