ACUSON SC2000 PRIME Ultrasound SystemPrecision at the Speed of Life

Baseline TEE Imaging

The baseline transesophageal echocardiography (TEE) exam shows:

1. The left ventricle (LV) systolic function is normal. The estimated LV ejection fraction is 64%.
2. Trivial pericardial effusion.
3. Mild concentric left ventricular hypertrophy (LVH).
4. Severe Aortic Stenosis (AS).
5. The LV diastolic function is abnormal. Stage II: Impaired (slow) early relaxation with decreased LV compliance (pseudonormalization pattern).
6. Severe bi-atrial enlargement.
7. Baseline left atrial appendage (LAA) measurements in 2D. 

The baseline transesophageal echocardiography (TEE) exam demonstrates a 4-chamber view of a severely enlarged left atrium (LA).

During the baseline transesophageal (TEE) exam the left atrial appendage (LAA) morphology was evaluated.

Using 2D TEE analysis, the LAA orifice diameter and depth are measured at 0 ⁰, 45 ⁰, 90 ⁰, and 135 ⁰.

Due to the nature of 2D echocardiography, there is a degree of uncertainty when the 2D landing zone diameters are performed in the same plane. This limitation can be overcome by using multiplanar reconstruction (MPR) parameters in 4D TEE imaging. Two long axis views of the LAA are aligned to visualize the short-axis of the LAA, allowing precise measurement of the landing zone diameter.

LAA landing zone size and LAA depth are measured during the baseline procedural assessment for the Watchman procedure. On 2D TEE, the LAA orifice diameter and depth are measured at 0⁰, 45 ⁰, 90 ⁰, 135 ⁰.

There can be a degree of uncertainty in 2D echocardiography because the landing zone diameter measurements are performed in the same place. This limitation can be overcome using multiplanar reconstruction (MPR) parameters in 4D TEE. 

LAA landing zone size and LAA depth are measured during the baseline procedural assessment for the Watchman procedure.

Due to the nature of 2D imaging planes, there can be degree of uncertainty because the 2D TEE landing zone diameter measurements are performed in the single plane. This limitation can be overcome using multiplanar reconstruction (MPR) techniques in 4D TEE.

Real-time guidance can be provided in 2D when crossing the septum in the inferior and posterior portion of the fossa ovalis.

Catheter positioning can also be seen with 4D TEE True Volume imaging to ensure that the catheter is positioned in a safe location post septal puncture.

Septal guide provides real-time guidance when crossing the septum. Catheter positioning can also be seen with 4D TEE True Volume imaging using the Single V navigation tool.

After the transseptal puncture has been guided by fluoroscopy and echo, the Watchman delivery system with pigtail catheter is advanced into the left atrium.

The Watchman device is then unsheathed slowly but remains attached to the delivery cable.

The delivery system is then guided into the left atrium using fluoro and echo guidance.

The guide catheter/pigtail is positioned so that the corresponding radiopaque marker band for the device size is aligned with the septum.

Before the Watchman device is released from the pigtail catheter, it must meet the PASS criteria:

* Position: Properly positioned – no tilt

* Anchoring: Tug Test

*Size: 15-30% compression

*Seal: No para-device leak

Using 2D TEE imaging, Watchman device for placement is observed.

4D TEE True Volume imaging has the advantage of allowing visualization of the entire lengths of the catheters as they traverse the left atrium to reach the left atrial appendage.

Using 4D TEE True Volume imaging, post deployment of the Watchman device is evaluated.

During the post deployment evaluation, utilizing 2D imaging and True Fidelity color Doppler no para-device leak is detected. A trivial interatrial septal leak is noted.

Using 2D imaging, no pericardial effusion and device embolization is observed.

The case illustrates the requirement for echocardiographic guidance to ensure proper sizing, positioning, device stability and compression of the Watchman device without any residual leaks. This case illustrates that 4D TEE True Volume imaging can overcome limitations of imprecise measurements in 2D imaging.

This case illustrates the requirement for echocardiographic guidance to ensure proper sizing, positioning, device stability and compression of the Watchman device without any residual leaks. The case illustrates that 4D TEE True Volume imaging can overcome limitations of imprecise measurements in 2D.

“The ACUSON SC2000 PRIME has really improved my ability to guide SHD interventions. What stands out above all is the color in both 2D and 4D to identify multiple eccentric jets, PVLs, and device leaks. The temporal resolution is much higher than that of conventional systems and the volume sector size is larger. The use of Artificial Intelligence applications in the system is also very helpful. I’m using eSie Valves for patients that can’t tolerate contrast CT for TAVR sizing, both for planning and during the procedure for confirmation.”

Dali Fan, MD, Ph.D. Associate Professor of Medicine UC Davis Medical Center, Sacramento, California, USA

The products/features mentioned in this document may not be commercially available in all countries. Due to regulatory reasons their future availability cannot be guaranteed. Please contact your local Siemens Healthineers

organization for further details.

Standalone clinical images may have been cropped to better visualize pathology.

ACUSON SC2000, eSie LVA, eSie Valves, True Volume and True Fidelity color Doppler

are trademarks of Siemens Medical Solutions USA, Inc.

Watchman is a registered trademark of Boston Scientific Corporation.

© Siemens Medical Solutions USA, Inc., 2020