Access to the PDF text

Free Article !

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.
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Article Outline
You can move this window by clicking on the headline