Simulation for Procedural Planning and Intracardiac Echo for Enhancing Precision in Cardiac Interventions With a Focus on Left Atrial Appendage Closure

Figures

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  Figure 1. Computer simulation for left atrial appendage closure using FEops technology. Abbreviations: CAUD, caudal; LA, left atrium; LAA, left atrial appendage; LAAC, left atrial appendage closure; RAO, right anterior oblique.

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  Figure 2. Timeline of the evolution of intracardiac echo and use in structural interventions. Abbreviations: ASD, atrial septal defect; PDA, patent ductus arteriosus; PFO, patent foramen ovale; PVL, paravalvular leak; PVR, pulmonary valve replacement; TAVI, transcatheter aortic valve replacement; VSD, ventricular septal defect.

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  Figure 3. Intracardiac echo—basic home views from the right atrium. With the ICE catheter in the right atrium, clockwise rotations will allow the sequential views shown above. Abbreviations: CS, coronary sinus; ICE, intracardiac echocardiography; LA, left atrium; LV, left ventricle; LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; LVOT, left ventricular outflow tract; MV, mitral valve; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract; TV, tricuspid valve.

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  Figure 4. Use of intracardiac echocardiography for percutaneous left atrial appendage closure. ICE catheter in the lateral RA to visualize IAS for transseptal puncture in the optimal position, usually inferior-posterior. Advancing the ICE catheter through the single transseptal puncture aligned with the guide catheter. Double transseptal puncture has also been shown to be safe. Position the ICE catheter in the LSPV, mid-LA, and supra-mitral position with posterior flex to assess LAAC device position and the PASS criteria for release. Abbreviations: IAS, interatrial septum; ICE, intracardiac echocardiography; LA, left atrium; LAA, left atrial appendage; LAAC, left atrial appendage closure; LCx, left circumflex; LSPV, left superior pulmonary vein; LV, left ventricle; MV, mitral valve; PA, pulmonary artery; RA, right atrium; PASS, position, anchor, size, seal.

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  Figure 5. When to consider left atrial appendage closure with intracardiac echocardiography? Abbreviations: ASD, atrial septal defect; CT, computed tomography; ICE, intracardiac echocardiography; LAAC, left atrial appendage closure; TEE, transesophageal echocardiography.