Echocardiography in the Cardiac Catheterization Laboratory

3 Echocardiography in the Cardiac Catheterization Laboratory






Echocardiographic Techniques


Multiple echocardiographic techniques are used during interventional procedures. The choice of technique is determined by technical issues associated with the modality, experience with the technique, and the use of general anesthesia.


The simplest technique is TTE. The supine position of the patient and the fluoroscopic imaging equipment may increase the complexity of image acquisition. Careful attention is required in order not to contaminate the sterile field. Despite these limitations, this technique is capable of providing good-quality imaging.


TEE provides excellent imaging and is the standard technique for most centers. This technique usually requires general anesthesia.


ICE uses an ultrasound catheter that is steerable and deflectable. The most commonly used catheter (AcuNav catheter; Biosense Webster, Diamond Bar, CA) comes in 8- and 10-French sizes. It has a 64-element vector phased-array transducer (5.5–10 MHz) at the tip of the catheter. It produces a two-dimensional (2D) sector of 90 degrees with color Doppler imaging. ICE can be performed by the interventionalist without the need for an echocardiographer. The greatest limitation of this technique is the catheter cost.


Real-time three-dimensional (3D) echocardiography is a more recently developed technique that can be used to image the anatomy, catheters, and devices. It allows for improved understanding of the relationships between the device and cardiac structures. The image quality and resolution are inferior to those of the other 2D techniques (Table 3-1).




Transcatheter Closure of Atrial Septal Defects/Patent Foramen Ovale



Technique


TEE is most often used. It provides excellent image quality. ICE provides comparable image quality without the need for general anesthesia.



Step-by-Step Approach



1 Assess Anatomy


Secundum ASDs and PFO are amenable to transcatheter closure.



Key Points













Jun 11, 2016 | Posted by in CARDIOLOGY | Comments Off on Echocardiography in the Cardiac Catheterization Laboratory

Full access? Get Clinical Tree

Get Clinical Tree app for offline access