The Utility of Intracardiac Echocardiography Following Melody™ Transcatheter Pulmonary Valve Implantation.

Abstract

The aim of this study was to determine the utility of intracardiac echocardiography (ICE) in assessing Melody™ transcatheter pulmonary valve (TPV) function immediately following valve implantation. ICE is used increasingly in percutaneous cardiac interventions. At our center, ICE is routinely utilized to evaluate valve function following Melody TPV implantation, but the utility of this practice remains unclear. A retrospective review of all Melody valves placed in the right ventricular outflow tract from April 2010 to September 2013 was performed. The clinical utility of ICE was described, along with the relationship between ICE data and traditional hemodynamic/angiographic data. ICE was performed in 54 cases and provided excellent Melody TPV visualization with no complications. ICE did not change clinical management but did provide supplemental information in two cases. In one case, angiography showed severe catheter-related Melody insufficiency. Subsequent ICE confirmed no insufficiency and prevented the need for additional angiography. In the second case, ICE allowed characterization of the mechanism of a residual gradient. ICE did not detect any clinically significant paravalvar leaks or valvar insufficiency not seen by angiography. The peak catheterization gradient was more closely approximated by the mean ICE gradient (median difference -7.4% between measurements) than by the peak ICE gradient (median difference 58.3%; p<0.0001). ICE provides excellent and safe visualization following Melody TPV implantation but did not provide new clinical information impacting management in this series. Selective use of ICE in cases with more than expected valve insufficiency or larger than expected residual gradients may streamline use while maintaining optimal clinical outcomes.