Intrakardiale und intraluminale Echokardiographie zur Führung des Schirmchenverschlusses bei Vorhofseptumdefekt und zur Detaildiagnostik bei Aortendissektion

Abstract

This study sought to compare intracardiac echocardiography (ICE) with conventional quantitative cineangiography (QCA) for balloon-sizing of atrial septal defects (ASD) in order to develop a safe alternative to that radiation-exposing part of device-closure procedures. In 45 patients with ASD, the stretched balloon diameter was measured by both ICE and QCA. The latter was considered the gold standard and done in two perpendicular planes whereas ICE balloon sizing was performed in a single standard cut plane, only. Echocardiographic measurements underestimated the diameter, but to a low extent: 0.7+/-0.8 mm (r=0.98; p<0.001). As a tool for sizing, ICE is an accurate alternative to QCA in order to reduce radiation exposure. If ICE is used, the occluder should be oversized by about 1 mm to account for the slight underestimation inherent in ICE sizing. Transesophageal echocardiography (TEE) and conventional intravascular ultrasound (IVUS) have limited capabilities in type B aortic dissection. To evaluate its diagnostic value, intraluminal phased-array imaging was compared with IVUS and TEE. In 23 patients with type B aortic dissection, IPAI was tested with respect to its ability to depict true and false lumen (TL, FL) and to identify all entries. Intraluminal echocardiography detected more entries than IVUS (3.0+/-1.2 vs. 0.8+/-0.5; p<0.001) and thoracic IPAI depicted more entries than TEE (1.8+/-1.0 vs. 1.2+/-0.5; p<0.001). In the detailed diagnostic evaluation of type B aortic dissection, intraluminal echocardiography is superior to IVUS and TEE in detecting communications between the TL and FL.