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Structural heart interventions are guided by transoesophageal or intracardiac echocardiography (TEE/ICE). MicroTEE, developed for paediatric purposes, is smaller and therefore less invasive and traumatic, avoiding the need for general anaesthesia. We aimed to show feasibility of procedural guidance by comparing image quality of microTEE with standard TEE and ICE during adult transcatheter interventions, and assess the accuracy in obtaining left atrial appendage (LAA) measurements between the microTEE probe and standard TEE.
We prospectively included 49 patients (20 women, 64 ± 18 years). Intraprocedural images were obtained by using the microTEE probe and standard (2D and 3D) TEE (LAA closure, MitraClip implantation) or ICE (interatrial communication closure, transseptal puncture for left atrial ablation). Two echocardiographers independently assessed image quality from 1 (excellent) to 4 (poor) and performed LAA measurements. Use of microTEE was not related to significant discomfort. Image quality obtained with the microTEE probe was lower than with standard TEE (2 [1–2] vs. 1 [1–2]; p = 0.04) and comparable with ICE images (2 [1–2] vs. 2 [1–2], p = 0.13). MicroTEE showed a wider field of view than ICE. LAA measurements on images obtained by microTEE were strongly associated with standard TEE.
MicroTEE seems feasible for guidance during transcatheter heart interventions in adults. MicroTEE imaging offers a wider field of view than ICE, and its accuracy is comparable with TEE. In transcatheter interventions performed under conscious sedation, microTEE might be a viable and advantageous alternative to standard TEE or ICE.
Swaans MJ, Michiels V, Nijenhuis VJ, Heijmen RH, ten Berg JM. Transcatheter mitral paravalvular leakage closure: A beautiful last resort. J Cardiol Cases. 2014;10:147–9. CrossRef
Swaans MJ, Post MC, van den Branden BJL, van der Heyden JAS. A complicated transseptal puncture during Mitraclip procedure: saved by 3D-TEE. Eur J Echocardiogr. 2011;12:E45. PubMed
Hilberath JN, Oakes DA, Shernan SK, Bulwer BE, D’Ambra MN, Eltzschig HK. Safety of transesophageal echocardiography. J Am Soc Echocardiogr. 2010;23:1115:27–21.
Wunderlich NC, Swaans MJ, Küx H, Beigel R, Siegel RJ. Echo essentials for endoluminal LAA closure. Card Interv Today. Afr J Med Med Sci. 2014;8:40:7.
- Feasibility of multiplane microtransoesophageal echocardiographic guidance in structural heart disease transcatheter interventions in adults
V. J. Nijenhuis
N. C. Wunderlich
B. J. W. M. Rensing
J. M. ten Berg
M. J. Suttorp
L. V. A. Boersma
J. A. S. van der Heyden
M. J. Swaans
- Bohn Stafleu van Loghum