Intracardiac Echocardiography: A New Guiding Tool for Transcatheter Aortic Valve Replacement Thomas Bartel, MD, Nikolaos Bonaros, MD, Ludwig Müller,

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Date of download: 6/22/2016 Copyright © The American College of Cardiology. All rights reserved. From: Management of coronary artery fistulae: Patient.

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Intracardiac Echocardiography: A New Guiding Tool for Transcatheter Aortic Valve Replacement Thomas Bartel, MD, Nikolaos Bonaros, MD, Ludwig Müller, MD, Guy Friedrich, MD, Michael Grimm, MD, Corinna Velik-Salchner, MD, Gudrun Feuchtner, MD, Florian Pedross, PhD, Silvana Müller, MD Journal of the American Society of Echocardiography Volume 24, Issue 9, Pages 966-975 (September 2011) DOI: 10.1016/j.echo.2011.04.009 Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 1 Longitudinal transcaval/transatrial (A) and short-axis transatrial (B) standard intracardiac echocardiographic views for TAVR. AAo, Ascending aorta; AC, AcuNav catheter; AVP, aortic valve prosthesis; DAo, descending aorta; IVC, inferior vena cava; LV, left ventricle; RA, right atrium; RV, right ventricle; SVC, superior vena cava. Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 2 Transesophageal echocardiographic viewing needs to be interrupted during valve deployment and the probe withdrawn (A), because it would interfere with standard fluoroscopic viewing. After valve deployment, the probe is repositioned to assess the functional result. However, the valve prosthesis is then concealed behind the probe (B). Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 3 Measurement of anterior-to-posterior annular diameter in the longitudinal transcaval intracardiac echocardiographic view (see Video 1 [see video clip online]). Ao, Aorta; LV, left ventricle. Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 4 Longitudinal transcaval (A) and short-axis (B) intracardiac echocardiographic views of aortic valve prosthesis after deployment and at end-diastole (see Videos 2 and 3 [see video clip online]). Ao, Aorta; AVP, aortic valve prosthesis; LV, left ventricle; 1, minimal paravalvular leak; RA, right atrium; RCA, right coronary artery. Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 5 Intracardiac spectral Doppler analyses of the native aortic valve (A), after predilatation (B), and after deployment of a 23-mm-diameter Edwards Sapien transcatheter heart valve prosthesis (C) on the basis of highest signal quality reveal decline of pressure gradient (PG) (see Videos 4 and 5 [see video clip online]). Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 6 Comparative measurements of transvalvular pressure gradients reveal higher gradients in group 1 (measurements were possible in all patients [n = 25]) (diamonds) than in group 2 (measurements were possible in a small majority of patients [n = 11]) (squares) under all conditions: native aortic valve (A) (P = .031), after predilatation (B) (P = .001), and after deployment of the valve prosthesis (C) (P < .001). Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 7 Longitudinal intracardiac echocardiographic view demonstrates both coronary arteries branching off above the opened aortic valve prosthesis. Ao, Aorta; LCA, left coronary artery, RCA, right coronary artery. Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 8 Regression analysis of preprocedural transesophageal versus intraprocedural intracardiac measurements of posterior-to-anterior aortic annular diameter in group 1. Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions

Figure 9 Comparison between left ventricular ejection fraction (LVEF) (percentage) after valve deployment on ICE (group 1) and TEE (group 2). Journal of the American Society of Echocardiography 2011 24, 966-975DOI: (10.1016/j.echo.2011.04.009) Copyright © 2011 American Society of Echocardiography Terms and Conditions