Intracardiac Echocardiography-Guided Device Closure of Non-PFO/ASD Shunts

Abstract

ABSTRACTBackground: Intracardiac echocardiography (ICE) has been used during transcatheter closure of simple atrial level shunts, but its use in more complex shunt lesions has not been well described.Methods: We conducted a retrospective review of all cases of ICE use at Mayo Clinic from January 2002 to December 2013. We selected cases where ICE was used during closure of non-atrial septal defiects/patent foramen vale shunts. Data were collected about patient demographics, type and location of shunt, type of anesthesia used, use of additional imaging modalities, procedure duration, fluoroscopy time, type of device used, residual shunt at conclusion of the procedure, complications, and residual shunt at follow-up.Results: A total of 1521 procedures involving the use of ICE were performed during the study period. Thirteen patients (8 males, 61%) underwent 14 qualifying procedures. Median age at time of intervention was 54 (range 11–73) years; median weight was 73 (37–99) kg. The most common lesions were congenital or iatrogenic ventricular septal defect (n = 5, 38%), aorta-atrial shunt (n = 3, 23%), and coronary artery fistula (n = 2, 15%). Median procedure duration and fluoroscopy time were 133 (38–192) minutes and 34 (16–91) minutes, respectively. General anesthesia was used for only 4/14 procedures. There were no complications associated with ICE use. After a median follow-up duration of 47 (7–95) months, four patients had small residual shunts seen on echocardiography, only one of whom required repeat intervention.Conclusions: ICE may be helpful in directing transcatheter closure of complex intracardiac shunts. In most cases, ICE can be performed without the use of general anesthesia.