ECHO 2013 / Interventional Echocardiography
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ASD: Improvement in Balloon
Sizing
Pitfalls of Balloon Sizing:
Oversizing of ASD (?aortic erosion)
iatrogenic enlargement of the ASD
thoracic pain
rupture of interatrial septum
ICE
Accurate sizing
Shortens procedure
time
Minnesota Wiggle
Test
PFO Closure Devices LA Arm
Cardioseal Device
Echo in Septal Closure
Transcatheter device closure has become an established treatment option for patients with ASDs.
(Chan KC, et al. Heart 1999;82:300)
TEE provides information that makes this interventional catheterization procedure easier, safer and more effective than using fluoroscopic guidance alone.
Application of real-time 3D TEE is feasible for the guidance of percutaneous transcatheter ASD and PFO
closures. During PFO closure, 3D TEE offers better spatial orientation of left atrial structures
(Balzer J, et al. Eur Heart J 2008;29:2226)
Transcatheter Closure of
Post-infarct VSD
Devices:
Amplatzer Muscular VSD occluder: waist 7 mm
Amplatzer Muscular VSD occluder post-infarction (PI): waist 10 mm (not available in US)
Patient Selection:
Exact localization of the VSD within the septum is of
paramount importance of the subsequent stability of the device
Echocardiography prior to device implantation is crucial for optimal patient selection
Kaulfersch C et al Minerva Cardioangiologica 2007;55(5):693-701
Echo in VSD closure
In initial clinical experiences using the Amplatzer Membranous VSD Occluder device to close membranous VSDs, 2D-TEE was effectively used to guide the safe and
successful performance of these complex procedures.
(Hijazi ZM, et al. Catheter Cardiovasc Interv. 2002;56:508)
In larger studies of VSD closure, 2D-TEE has been the 
main imaging modality used with optimal imaging for
device positioning and only limited use of ICE guidance.
(Fu YC, et al. J Am Coll Cardiol. 2006;47:319)
Traumatic VSD
Transcatheter Closure Attempt
85 yo woman, S/P apical MI 5 days
PTA, now with progressive SOB
Direct RV puncture
Transcatheter Closure Attempt
Delivery catheter through VSD
RV Umbrella: Waist too short
LV |
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Translocation |
Umbrella |
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into LV apex |
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LAA Thrombus
Kleeman et al. Eur J Echocardiogr 2009;10:383-8
295 pts with CHADS2 score 0 or 1, had LAA thrombus by TEE of 3% and dense smoke of 8%
11% of pts with low score had an indication for anticoagulation by TEE
LA thrombus or Spont Echo Contrast A/W 3x in 5 yr mortality
Stoddard et al. JACC 1995;25(2):452-9
LAA thrombus in 20% of pts with Afib undergoing TEE
Chronic Afib prevalence = 27%
Acute (<3 d) Afib prevalence = 14%
SPAF Investigators, Ann Int Med 1998;128:639-47
SEC nearly triples risk of stroke in atrial fibrillation
Morphology - Categorize by LAA Type
The WindSock Type LAA is |
The ChickenWing Type LAA is an |
The Broccoli Type LAA is an |
an anatomy in which one |
anatomy whose main feature is a |
anatomy whose main feature is |
dominant lobe of sufficient |
sharp bend in the dominant lobe of |
an LAA that has limited overall |
length is the primary |
the LAA anatomy at some distance |
length with more complex |
structure. |
from the perceived LAA ostium. |
internal characteristics. |