ECHO 2013 / Interventional Echocardiography
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Watchman LAA Closure
Initial Position
Final Position
LARIATTM (by SentreHEART)
EndoCATH
Snare 
LAA
FWZ
Transseptal
SofTIP
J Cardiovasc Electrophysiol, 2009
LARIATTM (by SentreHEART)
LARIATTM (by SentreHEART)
Echocardiographic guidance of the
LAA transcatheter occlusion is essential and the quality of ultrasound images exceeds fluoroscopy.
(Mraz T, et al. Echocardiogr. 2007;24:401)
Alcohol Septal Ablation
ASA debulks the septum and reduce the subaortic gradient
Injection of ethanol into septal perforator supplying the muscle mass 
adjacent to the point mitral leaflet-septal contact, causes a localized myocardial infarction which widens the LVOT, relieving obstruction
Result:
Acute reduction in gradient in the cath lab
Increase in gradient within 24 hours,
Significant reduction in gradient over 6-12 months due to further remodeling and thinning of the affected septum
Role of Echocardiography
Echocardiography:
Reduced rates of heart block (25% to 10%)
Primary imaging modality for patient selection
15-20% inappropriate septal perforator anatomy
Pre-procedural Patient Selection
≥ 50 mmHg pk gradient (rest or with provocation)
Confirm outflow obstruction secondary to SAM
Patients with congenital abnormalities of the mitral or malpositioning of enlarged papillary muscles with mid-cavity obstruction are not candidates for ablation
Faber L, et al. Circulation. 1998;98:2415 OkajimaK, et al. Circulation. 2006;114:II 762
Hypertrophic Cardiomyopathy
59 year old male
Case
Vmax = 4.8 m/s
Pk Gradient = 92 mmHg
Mn Gradient = 42 mmHg
Case
CONTRAST Injection
Vmax = 1.05 m/s
Pk Gradient = 8 mmHg Mn Gradient = 4 mmHg
Case
REST:
Vmax = 1.3 m/s
Pk Gradient = 12 mmHg Mn Gradient = 7 mmHg
Valsalva:
Vmax = 1.5 m/s
Pk Gradient = 24 mmHg Mn Gradient = 11 mmHg
Post-APC:
NSR Grad = 12 mmHg APC Grad = 29 mmHg