Intracardiac Echocardiography to Guide Structural Heart Disease Interventions-Dr. Goldsweig slides

Dr. Goldsweig slides

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This document presents a detailed overview of Left Atrial Appendage Occlusion (LAAO) procedures guided by Intracardiac Echocardiography (ICE), emphasizing standardized imaging views and nomenclature. Authored by Dr. Andrew M. Goldsweig, an expert in cardiovascular clinical research, the material underscores the value of specific ICE-guided views for effective LAAO.<br /><br />Key standardized echocardiographic views highlighted for LAAO include the "Home" view, left ventricle (LV) seen from the right ventricle (RV), left atrial appendage (LAA) from the pulmonary artery (PA), septal view, and distinct LAA views categorized as mitral, aortic, and pulmonic. These views correspond to specific three-dimensional ICE (3D-ICE) transseptal positions, which mirror transesophageal echocardiography (TEE) views — “Mitral Valve” (mid LA 0°/90°), “Aortic Valve” (mid LA -45°/45°), and “Pulmonic Valve” (mid LA 45°/135°). These perspectives support precise visualization of the LAA anatomy and device positioning.<br /><br />The document features a clinical case of an 84-year-old female with permanent atrial fibrillation and high stroke risk (CHA2DS2-VASc score of 5), complicated by bleeding on anticoagulation and fall-related trauma, who underwent ICE-guided LAAO. Imaging revealed an anterior chicken-wing morphology of LAA. The procedure utilized dual femoral venous access with stepwise ICE imaging through the standardized views, including biplane imaging during device deployment and final confirmation.<br /><br />Overall, Dr. Goldsweig advocates reclaiming and clarifying the term "ICE" within cardiology to enhance procedural guidance for LAAO. The approach improves procedural safety and efficacy by providing clear, uniform imaging strategies. The document also references Dr. Goldsweig’s affiliations and disclosures involving medical device companies and clinical trials.

Keywords

Left Atrial Appendage Occlusion

Intracardiac Echocardiography

Standardized Imaging Views

3D-ICE Transseptal Positions

Transesophageal Echocardiography

Atrial Fibrillation

CHA2DS2-VASc Score

Chicken-Wing Morphology

Dual Femoral Venous Access

Biplane Imaging