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Review
. 2022 Oct 6:9:1012731.
doi: 10.3389/fcvm.2022.1012731. eCollection 2022.

Intracardiac echocardiography Chinese expert consensus

Zhong Jingquan  1   2 , Long Deyong  3 , Chu Huimin  4 , Fu Hua  5 , Han Xuebin  6 , Jiang Chenyang  7 , Li Yan  8 , Li Xuebin  9 , Tang Min  10 , Wang Zulu  11 , Xue Yumei  12 , Zhang Jinlin  13 , Zhang Wei  8 , Zhang Xiaochun  14 , Zhou Daxin  14 , Zhang Yun  1 , Ma Changsheng  3 , Paul C Zei  15 , Luigi Di Biase  16
Affiliations
Review

Intracardiac echocardiography Chinese expert consensus

Zhong Jingquan et al. Front Cardiovasc Med. .

Abstract

In recent years, percutaneous catheter interventions have continuously evolved, becoming an essential strategy for interventional diagnosis and treatment of many structural heart diseases and arrhythmias. Along with the increasing complexity of cardiac interventions comes ever more complex demands for intraoperative imaging. Intracardiac echocardiography (ICE) is well-suited for these requirements with real-time imaging, real-time monitoring for intraoperative complications, and a well-tolerated procedure. As a result, ICE is increasingly used many types of cardiac interventions. Given the lack of relevant guidelines at home and abroad and to promote and standardize the clinical applications of ICE, the members of this panel extensively evaluated relevant research findings, and they developed this consensus document after discussions and correlation with front-line clinical work experience, aiming to provide guidance for clinicians and to further improve interventional cardiovascular diagnosis and treatment procedures.

Keywords: arrhythmia; cardiomyopathy and pulmonary arterial hypertension; congenital heart disease; device implantation and lead extraction; intracardiac echocardiography; left atrial appendage closure; structural heart disease; transseptal puncture.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Intracardiac (ICE)-guided zero X-ray transseptal puncture. (A) Guidewire and sheath seen in SVC. (B) “Tenting sign” in the fossa ovalis by puncture needle sheath. (C) Saline injection microbubbles into the left atrium after the needle is inserted. (D) Needle tip into the left atrium. SVC, superior vena cava; LA, left atrium.
FIGURE 2
FIGURE 2
Intracardiac echocardiography-guided cryoablation. (A) ICE-guided low transseptal puncture; (B) cryoablation sheath delivered through the low transseptum; (C) cryoballoon delivered into the left superior pulmonary vein under ICE guidance; (D) ICE color Doppler ultrasound applied to assess cryoballoon closure.
FIGURE 3
FIGURE 3
Intracardiac echocardiography combined with fast anatomical reconstruction for left atrial model reconstruction. FAM, fast anatomical mapping; Merge, ICE combined with three-dimensional reconstruction; CPVA, circumferential pulmonary vein ablation.
FIGURE 4
FIGURE 4
Ventricular premature beat between left and right coronary cusps. NCC, non-coronary cusp; RCC, right coronary cusp; LCC, left coronary cusp; LA, left atrium; LAA, left atrial appendage.
FIGURE 5
FIGURE 5
Ventricular premature beat of left ventricular posterior papillary muscle. IVS, interventricular septum; LV, left ventricle; APM, anterior papillary muscle; PVOT, right ventricular outflow tract; PPM, posterior papillary muscle; RV, right ventricle; LV, left ventricle.
FIGURE 6
FIGURE 6
Ventricular premature beat of left ventricular anterior papillary muscle. LV, left ventricle; APM, anterior papillary muscle; TV, tricuspid valve; PVOT, right ventricular outflow tract; PPM, posterior papillary muscle; RV, right ventricle; LV, left ventricle.
FIGURE 7
FIGURE 7
Ventricular premature beat originating from the tricuspid annulus. RA, right atrium; TV, tricuspid valve; RV, right ventricle.
FIGURE 8
FIGURE 8
Application of ICE in ischemic cardiomyopathy with ventricular aneurysm-induced ventricular tachycardia.
FIGURE 9
FIGURE 9
Patent foramen ovale closure procedure guided by ICE. (A) PFO slit (green arrow). (B) The guidewire passes through the PFO slit (yellow arrow points to the highlighted echo which represents the guidewire, and green arrow points to the left superior pulmonary vein). (C) Send the delivery sheath to the ostium of the left superior pulmonary vein. (D) Release the left plate of the closure device (the yellow arrow points to the left plate). (E) Perform a pull test after the closure device is fully expanded. (F) The closure device is released. PFO, patent foramen ovale.
FIGURE 10
FIGURE 10
Multi-angle left atrial appendage measurement. From the top to bottom: schematic diagrams for atrial appendage assessment, X-ray images, ultrasound images and 3D electroanatomical diagrams from X axis, Y axis, and Z axis. The projection position of the X-ray is AP. The first column shows the schematic diagrams, the second column shows the effect of X-ray, the third column shows the images of ICE, and the fourth column shows the images of 3D mapping system. LAA, left atrial appendage; LSPV, left superior pulmonary vein; LIPV, left inferior pulmonary vein; LA, left atrium; RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein; LCX, left circumflex artery; Ant., anterior; Sup., superior; R, right; L, left; MA, mitral annulus; RPV, right pulmonary vein.
FIGURE 11
FIGURE 11
Process of ICE-guided LAAC. (A) Send the delivery sheath to the ostium of LAA (green arrow), and the pigtail catheter to the inside of LAA (small white arrow), and note the position of the LCX (yellow arrow). (B) Expand the closure device fixation disk, and note that it should be medial to the LCX (orange arrow). (C) Expand the closure disk. (D) Slightly withdraw the closure device (disk). (E) Pull test. (F) There is no residual shunt at the edge of the closure device as assessed by color Doppler flow monitoring at the end of closure. ICE, intracardiac echocardiography; LAA, left atrial appendage; LCX, left circumflex artery.
See this image and copyright information in PMC

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