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Archives of cardiovascular diseases
Volume 106, n° 4
pages 259-260 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.040
LAA closure monitoring by transesophageal echocardiography using ice probe
 

J. Ternacle, N. Lellouche, R. Gallet, P. Gueret, J.-L. Dubois-Rande, E. Teiger, P. Lim
 Hôpital Henri-Mondor, Créteil, France 

Background .– Intracardiac echocardiography probe can be used trough esophageal route (ICE-TEE) to monitor transeptal puncture and evaluate left atrial appendage (LAA) without requiring general sedation. The purpose of the study is to evaluate the accuracy and the safety of ICE-TEE during Amplatzer Cardiac Plug (ACP) implantation.

Methods .– The study included 16 consecutive patients (75±7years) in atrial fibrillation with high-risk of embolism (CHAD-Vasc=5±1.4) that required LAA closure by ACP because of severe bleeding complications occurring under vitamin K antagonist (HAS-BLED=4±0.9). Standard TEE was performed the day before the device implantation for LAA sizing and excluding thrombosis. During the procedure, ICE-TEE was used under local anesthesia to determine ACP diameter (ACP diameter=1.2*LAA diameter by ICE-TEE) and monitor ACP positioning. LAA size by ICE-TEE was compared to the size obtained by fluoroscopy and standard TEE and ACP lobe size after device implantation by ICE-TEE to cardiac computed tomography (CT).

Results .– LAA maximal diameter by ICE-TEE did not differ from TEE (21±3mm vs. 20±3mm, r =0.9, P <0.001), while fluoroscopy measurement was lower (19±3mm, P <0.05 vs. ICE-TEE and P =0.08 vs. TEE). ACP was successfully implanted in 13 patients after one device, two patients after two devices and one failed because of a complex LAA anatomy. As expected ACP diameter implanted was 1.2±0.04 (mean=25±3mm,26mm in 10/16 patients) greater than LAA size measured by ICE-TEE. ACP size by ICE-TEE at the end of the procedure was similar to cardiac CT measurement (23±7mm vs. 23±4mm, R=0.98, P <0.001). Finally, the procedure (mean duration=62±27minutes, X-ray exposure=78±51Gray/m2) was safely conducted in all without pericardial effusion and prosthesis migration.

Conclusions .– ICE-TEE probe through esophageal route may be used for the sizing and the monitoring of ACP device implantation. Compared to standard TEE, ICE-TEE does not required general sedation.



© 2013  Published by Elsevier Masson SAS.
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