Earing Michael G, Cabalka Allison K, Seward James B, Bruce Charles J, Reeder Guy S, Hagler Donald J
Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2004 Jan;79(1):24-34. doi: 10.4065/79.1.24.
To describe our experience with intracardiac echocardiographic (ICE) guidance during transcatheter device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) and to describe a detailed stepwise approach for performing ICE examinations.
We reviewed the ICE results of all patients who underwent transcatheter device closure of ASD/PFO at the Mayo Clinic in Rochester, Minn, between October 2000 and November 2002. Conscious sedation was used, and all ICE studies were performed using a diagnostic ultrasound catheter.
Ninety-four patients (47 male; median age, 51 years [range, 17-81 years]) underwent ICE during transcatheter device closure of ASD/PFO. Total procedure time was 128 minutes (range, 27-320 minutes). ICE identified a previously unrecognized anatomical diagnosis in 32 of 94 patients. An additional ASD or PFO was found in 16 patients; a redundant atrial septum or an atrial septal aneurysm was found in 12 patients. There were few ICE complications (4%): 3 patients developed atrial fibrillation, and 1 developed supraventricular tachycardia; of these 4, 2 resolved spontaneously, and 2 required cardioversion with no recurrence.
ICE provides anatomical detail of ASD/PFO and cardiac structures facilitating congenital cardiac interventional procedures. ICE eliminates major drawbacks related to the use of transesophageal echocardiographic guidance for transcatheter device closure of ASD/PFO, specifically problems related to airway management. Finally, ICE gives the interventional cardiologist the ability to control all aspects of imaging without relying on additional echocardiographic support. We believe that ICE should be considered the preferred imaging technique for guidance of transcatheter device closure of ASD/PFO in adults and larger pediatric patients.
描述我们在经导管封堵房间隔缺损（ASD）和卵圆孔未闭（PFO）过程中使用心内超声心动图（ICE）引导的经验，并描述进行ICE检查的详细分步方法。
我们回顾了2000年10月至2002年11月在明尼苏达州罗切斯特市梅奥诊所接受经导管封堵ASD/PFO的所有患者的ICE结果。采用清醒镇静，所有ICE检查均使用诊断性超声导管进行。
94例患者（47例男性；中位年龄51岁[范围17 - 81岁]）在经导管封堵ASD/PFO过程中接受了ICE检查。总手术时间为128分钟（范围27 - 320分钟）。ICE在94例患者中的32例中发现了先前未被识别的解剖学诊断。16例患者中发现了额外的ASD或PFO；12例患者中发现了多余的房间隔或房间隔瘤。ICE并发症很少（4%）：3例患者发生房颤，1例发生室上性心动过速；这4例中，2例自发缓解，2例需要心脏复律且无复发。
ICE提供了ASD/PFO及心脏结构的解剖细节，有助于先天性心脏介入手术。ICE消除了经导管封堵ASD/PFO使用经食管超声心动图引导的主要缺点，特别是与气道管理相关的问题。最后，ICE使介入心脏病学家能够在不依赖额外超声心动图支持的情况下控制成像的各个方面。我们认为，ICE应被视为成人及较大儿童患者经导管封堵ASD/PFO引导的首选成像技术。
