Real-time Volume ICE Improves Cardiac Interventions
Real-Time Volume Intracardiac Echocardiography Used in Clinical Application for the First Time Globally in Portugal.


Management Summary

Interventional procedures have become a therapeutic option for an increasing number of patients with structural heart disease. These interventions require comprehensive real-time image guidance, including TEE (transesophageal echocardiography). TEE makes intubation with full anesthesia necessary. This leads to a more complex and expensive procedure.


Centro Hospitalar Vila Nova de Gaia works with Siemens at the forefront of new technologies in cardiology – the ACUSON SC2000 ultrasound system and ACUSON AcuNav V ultrasound catheter enable real-time volume intracardiac echocardiography (ICE) imaging without the need for anesthesia to avoid TEE exams, thereby providing safer and more efficient procedures.


Safer cardiac treatments, shorter hospital stays and fewer surgical staff required since there is no need for full anesthesia.

When Dr. Vasco da Gama Ribeiro’s team came out of the cath lab one morning, they could scarcely contain their enthusiasm. In just 30 minutes, they had successfully occluded a left atrial appendage (LAA) guided by real-time volume intracardiac echocardiography (ICE): an innovative procedure.


Without General Anesthesia
The patient, who was treated using the ACUSON AcuNav™ V ultrasound catheter connected to the ACUSON SC2000™ ultrasound system, had congenital heart disease and atrial fibrillation. This is the most common cardiac arrhythmia and poses a high risk of embolic complications, such as stroke or mesenteric infarction. The thrombus formation typically occurs in the left atrial appendage. Guidelines recommend oral anticoagulation, but this was not possible in this patient because of the high risk of bleeding.



Benefit of Real-time Volume Image Guidance
In the past several years, a new treatment option – interventional closure of the LAA – has been developed for these patients. The procedure has demonstrated good results in various clinical studies. LAA closure is a challenging intervention that benefits especially from real-time volume image guidance. Typically, LAA closure is performed in the cath lab with additional transesophageal echocardiography (TEE) guidance.


Avoiding Intubation and Anesthesia
Due to the TEE probe positioned in the esophagus, patients need intubation with general anesthesia in order to reduce the risk of aspiration. "Real-time volume ICE images such as RT3D TEE gave us the necessary anatomical information to allow us to perform the procedure while avoiding the efforts and potential complications of intubation and anesthesia," explains cardiologist Dr. José Ribeiro, in charge of the echocardiography laboratory at CHVNG/E.




Improved Interventions
For cardiac interventions such as closure of the atrial appendage, closure of atrial septal defects, percutaneous aortic valve replacement (TAVR), or interventional therapy of paravalvular leakage, Dr. Vasco da Gama Ribeiro explains, "we rely on transesophageal echocardiography to guide the intervention. TEE requires intubation and general anesthesia, increasing the number of people in the cath lab and the periprocedural risk." Recovery time is the same for both methods; although complications related to anesthesia and intubation may occur with TEE that can extend the length of stay. “Using AcuNav V, the interventions mentioned above need only vascular access – the patient is sedated, and neither general anesthesia nor intubation is required. This decreases the periprocedural patient risk."


About the Author

Patricia Fonseca
Senior Writer/Editor, Visão newsmagazine Portugal, since 2003. Studied Journalism at the Washington University/Committee of Concerned Journalists, USA. Awards: EU Health Prize, Finalist (2012), Novartis Oncology Press Prize (2012).