Intracardiac echocardiogram

Last updated December 07, 2023

Intracardiac echocardiography (ICE) is a specialized form of echocardiography that utilizes an ultrasound-tipped catheter to perform imaging of the heart from within the heart. Unlike transthoracic echocardiography (TTE), ICE is not limited by body habitus. An ICE catheter is inserted into the body, typically, through the femoral vein and advanced into the heart.

Uses

The use of ICE is specialized and not intended for general echocardiography due to its cost and invasiveness.^[1]^[2] It is used as a part of a larger heart procedure. A typical use of ICE is for performing a transseptal puncture across the interatrial septum; in other words, pushing a catheter from the right atrium to the left atrium. Next to the septum is the aorta, and puncturing from the right atrium to the aorta is dangerous, and ICE visualization increases the confidence of performing this procedure safely.^{[ citation needed ]}

Risks

The use of an ICE catheter has the same risks of use and advancing any other catheter into the heart, namely cardiac wall puncture and bleeding into the space outside the heart (pericardial effusion) which can lead to cardiac tamponade. ^[2]

Common views

The "home view" of ICE^[1] is from within the right atrium and looking through the tricuspid valve into the right ventricle.

From the home view, clockwise rotation of the catheter will sweep the view through the aorta and to the interatrial septum used for transseptal pucnture.
From the home view, deflecting the catheter toward the tricuspid valve and advancing the catheter will place the tip inside the right ventricle. From there, clocking the catheter will sweep through the interventricular septum and the left ventricle. Further clockwise rotation will bring the aortic valve, aorta, pulmonary valve, and RV outflow tract into view.
After transseptal puncture, the ICE catheter can be advanced through the puncture into the left atrium. Rotation of the catheter to a "home view" of the left atrium through the mitral valve into the left ventricle. From there, a 180° rotation will face the posterior wall and posterior deflection will bring the left atrial appendage into view and can be used for deployment of a left atrial appendage occlusion device.

Carto-Sound

Of the electroanatomic mapping systems, Carto is the only system capable of integrating ICE imagery into the model with a module called Carto-Sound.^[3] Individual echo frames can be frozen and structures drawn that is translated into the 3-D model within Carto.

Procedural use

Use of ICE is often limited to invasive procedures such as:^[1]

Atrial septal defect closure
Left heart ablations such as for atrial fibrillation, atrial flutter, and ventricular tachycardia
Mitral valve repair (eg, MitraClip)
Percutaneous aortic valve replacement
Transseptal puncture

Limitations

ICE catheters are limited in size as they must be introduced inside the blood vessels. Limitation of the size of the catheter limits the ultrasound crystal and the image quality obtainable. However, because the catheter can be readily moved into close proximity of the desired structure, the quality limitation can be reduced.^{[ citation needed ]}

Related Research Articles

A heart valve is a biological one-way valve that allows blood to flow in one direction through the chambers of the heart. Four valves are usually present in a mammalian heart and together they determine the pathway of blood flow through the heart. A heart valve opens or closes according to differential blood pressure on each side.

The aortic valve is a valve in the heart of humans and most other animals, located between the left ventricle and the aorta. It is one of the four valves of the heart and one of the two semilunar valves, the other being the pulmonary valve. The aortic valve normally has three cusps or leaflets, although in 1–2% of the population it is found to congenitally have two leaflets. The aortic valve is the last structure in the heart the blood travels through before stopping the flow through the systemic circulation.

The mitral valve, also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two cusps or flaps and lies between the left atrium and the left ventricle of the heart. The heart valves are all one-way valves allowing blood flow in just one direction. The mitral valve and the tricuspid valve are known as the atrioventricular valves because they lie between the atria and the ventricles.

Systole is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood.

A ventricle is one of two large chambers toward the bottom of the heart that collect and expel blood towards the peripheral beds within the body and lungs. The blood pumped by a ventricle is supplied by an atrium, an adjacent chamber in the upper heart that is smaller than a ventricle. Interventricular means between the ventricles, while intraventricular means within one ventricle.

Echocardiography, also known as cardiac ultrasound, is the use of ultrasound to examine the heart. It is a type of medical imaging, using standard ultrasound or Doppler ultrasound. The visual image formed using this technique is called an echocardiogram, a cardiac echo, or simply an echo.

Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm² during diastole. Any decrease in area below 2 cm² causes mitral stenosis. Early diagnosis of mitral stenosis in pregnancy is very important as the heart cannot tolerate increased cardiac output demand as in the case of exercise and pregnancy. Atrial fibrillation is a common complication of resulting left atrial enlargement, which can lead to systemic thromboembolic complications such as stroke.

<span class="mw-page-title-main">Atrial septal defect</span> Human heart defect present at birth

Atrial septal defect (ASD) is a congenital heart defect in which blood flows between the atria of the heart. Some flow is a normal condition both pre-birth and immediately post-birth via the foramen ovale; however, when this does not naturally close after birth it is referred to as a patent (open) foramen ovale (PFO). It is common in patients with a congenital atrial septal aneurysm (ASA).

<span class="mw-page-title-main">Transesophageal echocardiogram</span> Type of echocardiogram

A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It is commonly used during cardiac surgery and is an excellent modality for assessing the aorta, although there are some limitations.

<span class="mw-page-title-main">Cardiac catheterization</span> Insertion of a catheter into a chamber or vessel of the heart

Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.

The atrium is one of the two upper chambers in the heart that receives blood from the circulatory system. The blood in the atria is pumped into the heart ventricles through the atrioventricular mitral and tricuspid heart valves.

A transthoracic echocardiogram (TTE) is the most common type of echocardiogram, which is a still or moving image of the internal parts of the heart using ultrasound. In this case, the probe is placed on the chest or abdomen of the subject to get various views of the heart. It is used as a non-invasive assessment of the overall health of the heart, including a patient's heart valves and degree of heart muscle contraction. The images are displayed on a monitor for real-time viewing and then recorded.

Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart. These conditions occur largely as a consequence of aging, but may also be the result of congenital (inborn) abnormalities or specific disease or physiologic processes including rheumatic heart disease and pregnancy.

<span class="mw-page-title-main">Foramen secundum</span>

The foramen secundum, or ostium secundum is a foramen in the septum primum, a precursor to the interatrial septum of the human heart.

<span class="mw-page-title-main">Valve of inferior vena cava</span>

The valve of the inferior vena cava is a venous valve that lies at the junction of the inferior vena cava and right atrium.

Regurgitation is blood flow in the opposite direction from normal, as the backward flowing of blood into the heart or between heart chambers. It is the circulatory equivalent of backflow in engineered systems. It is sometimes called reflux.

Lutembacher's syndrome is a very rare form of congenital heart disease that affects one of the chambers of the heart as well as a valve. It is commonly known as both congenital atrial septal defect (ASD) and acquired mitral stenosis (MS). Congenital atrial septal defect refers to a hole being in the septum or wall that separates the two atria; this condition is usually seen in fetuses and infants. Mitral stenosis refers to mitral valve leaflets sticking to each other making the opening for blood to pass from the atrium to the ventricles very small. With the valve being so small, blood has difficulty passing from the left atrium into the left ventricle. Septal defects that may occur with Lutembacher's syndrome include: Ostium primum atrial septal defect or ostium secundum which is more prevalent.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

Heart development, also known as cardiogenesis, refers to the prenatal development of the heart. This begins with the formation of two endocardial tubes which merge to form the tubular heart, also called the primitive heart tube. The heart is the first functional organ in vertebrate embryos.

The heart is a muscular organ situated in the mediastinum. It consists of four chambers, four valves, two main arteries, and the conduction system. The left and right sides of the heart have different functions: the right side receives de-oxygenated blood through the superior and inferior venae cavae and pumps blood to the lungs through the pulmonary artery, and the left side receives saturated blood from the lungs.

References

1 2 3 Enriquez, Andrea (2018). "Use of Intracardiac Echocardiography in Interventional Cardiology". Circulation. 137 (21): 2278–2294. doi: 10.1161/CIRCULATIONAHA.117.031343 . PMID 29784681. S2CID 29150833.
1 2 Otto, Catherine (2018). Textbook of Clinical Echocardiography (6th ed.). Elsevier. pp. 115–116. ISBN 978-0323480482.
↑ Biosense Webster. "CARTOSOUND® Module" . Retrieved 18 March 2023.

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[Enriquez2018-1] 1 2 3 Enriquez, Andrea (2018). "Use of Intracardiac Echocardiography in Interventional Cardiology". Circulation. 137 (21): 2278–2294. doi: 10.1161/CIRCULATIONAHA.117.031343 . PMID 29784681. S2CID 29150833.

[Otto2018-2] 1 2 Otto, Catherine (2018). Textbook of Clinical Echocardiography (6th ed.). Elsevier. pp. 115–116. ISBN 978-0323480482.

[3] Biosense Webster. "CARTOSOUND® Module" . Retrieved 18 March 2023.

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