Transoesophageal echocardiography (TEE) under general anesthesia (GA) is the reference technique to guide most of transcatheter cardiac structural interventions (TCI). However, the need for GA represents an important limitation in the context of the dramatic increase of this activity. Multiplane micro TEE probe (MMt) has recently emerged as an alternative imaging technique for procedural guidance that would not require GA. The aim is to evaluate the feasibility of the use of MMt to guide TCI without GA.

We report our 1-year experience of TCI guidance with MMt used during the whole procedure under conscious sedation or without sedation in specific situations requiring unplanned TEE guidance.

MMt was used during the following interventions:

– Patent Foramen ovale closure (n=73),

– Guidance of difficult transseptal catheterization during percutaneous mitral commissurotomy (n=6),

– Selected cases of assessment after TAVI requiring TEE to evaluate the final result (position, paravalvular leak) (n=5),

– MitraClip procedure with failure of conventional TEE (n=1).

Overall, the tolerance of the probe and the comfort of the patients were excellent. There was neither complication related to its use, nor conversion to GA and conventional TEE. Although the quality of imaging might be inferior to that of conventional TEE, the information was sufficient to guide the procedures in all cases. The absence of GA significantly shortened procedural time and interval between procedures.

This preliminary experience illustrates the role of MMt without GA during specific TCI, improving procedural time while preserving the comfort of the patients. In addition MMt appears particularly useful in patients requiring unplanned TEE during TCI. Despite some limitations, as the lack of 3-D imaging, we anticipate that MMt will play an important role in the context of increasing demand in interventional guidance.