3-dimensional intracardiac echocardiography for structural heart interventions

Figure 1. 3-dimensional intracardiac echocardiography for transcatheter mitral interventions. (A) Biplane transesophageal echocardiography in a severely dilated left atrium causing reduced spatial resolution of the mitral valve due to its far field position; (B) biplane intracardiac echocardiography in the same patient with improved visualization of the mitral valve, allowing for a successful mitral transcatheter edge-to-edge repair; (C) live 3-dimensional multi-planar reconstruction from an intracardiac echocardiography volume after deployment of a mitral transcatheter edge-to-edge repair device; (D) biplane intracardiac echocardiography during a transcatheter mitral valve-in-valve implantation. LA, left atrium; M, medial; L, lateral; LV, left ventricle; A, anterior; P, posterior.

Figure 2. 3-dimensional intracardiac echocardiography probe positioning for transcatheter mitral interventions. (A) Fluoroscopic view demonstrating the intracardiac echocardiography probe (white arrow) positioning with posterior flexion relative to a trans-septal puncture system to image the interatrial septum for trans-septal puncture; (B) fluoroscopic and 3-dimensional transesophageal echocardiographic views from posterior looking anterior (C) and from a surgeon's view above the mitral valve from the left atrium (D) demonstrating the intracardiac echocardiography probe (white arrow) positioning relative to the mitral valve for intraprocedural guidance of a transcatheter edge-to-edge repair. LA, left atrium; RA, right atrium; MV, mitral valve.

Figure 3. 3-dimensional intracardiac echocardiography for transcatheter tricuspid interventions. Biplane intracardiac echocardiographic evaluation of the tricuspid valve without (A) and with (B) color Doppler; (C) live 3-dimensional multi-planar reconstruction of the tricuspid valve with color-coded anatomic markers and two independently controlled short axis views on the bottom left (leaflet tip level on the left, annulus level on the right); (D) 3-dimensional en face view of a degenerated prosthetic tricuspid valve in diastole with two simultaneous 2-dimensional image plane reconstructions, obtained during a tricuspid valve-in-valve implantation. RA, right atrium; RV, right ventricle; A, anterior; P, posterior; S, septal; L, lateral.

Figure 4. 3-dimensional intracardiac echocardiography for transcatheter atrial septal evaluation and interventions. (A) Biplane intracardiac echocardiography evaluation of the interatrial septum in bicaval-like (left) and 4-chamber-like (right) views; (B) biplane intracardiac echocardiography evaluation of the interatrial septum in bicaval-like (left) and aortic short axis (right) views; (C) biplane intracardiac echocardiography evaluation of an atrial septal defect in aortic short axis (left) and orthogonal (right) views; (D) biplane intracardiac echocardiographic guidance of a transcatheter atrial septal defect closure. RA, right atrium, SVC, superior vena cava; LA, left atrium; LV, left ventricle; ASD, atrial septal defect.