3D Intracardiac Echocardiography for Structural Heart Interventions

Transcatheter structural heart interventions are expanding into more complex spaces including mitral transcatheter edge-to-edge repair, left atrial appendage occlusion, tricuspid transcatheter edge-to-edge repair, mitral/tricuspid valve-in-valve, and perivalvular leak closures. Transesophageal echocardiography (TEE), with concomitant fluoroscopy, has remained the gold standard for many of these interventions. Although three-dimensional intracardiac echocardiography has been used, applications were often limited to guidance for more "simple" procedures such as patent foramen ovale/atrial septal defect closure and/or intraprocedural adjunctive imaging guidance. However, patients with an excessive risk for general anesthesia or contraindications to TEE, including esophageal/gastric disease, cervical/thoracic spinal disease, or coagulopathies, have limited options.