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- percutaneous interventions
- transoesophageal echocardiography
- intracardiac echocardiography
- three-dimensional echocardiography
- echocardiography (transoesophageal)
- non-coronary intervention
- device closure
- percutaneous valve therapy
The variety and complexity of percutaneous catheter based procedures performed in the catheterisation laboratory has considerably increased over recent years. In addition to well established procedures such as transcatheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO), balloon mitral valvuloplasty (BMV), and transcatheter alcohol septal ablation (TASH) for hypertrophic cardiomyopathy, more complex percutaneous procedures have been developed recently, such as percutaneous left atrial appendage (LAA) closure and percutaneous aortic and mitral valve interventions.
Parallel to the development of these techniques, the role of imaging and especially echocardiography has become of crucial importance in the catheterisation laboratory for the guidance, optimisation of results and detection of complications during these procedures.
In contrast to fluoroscopy and angiography, echocardiography provides direct assessment of soft tissues and cardiac anatomy, and can assess the relationship between catheters or devices and adjacent structures.
Transthoracic, transoesophageal, and intracardiac echocardiography are now routinely used as an adjunct to fluoroscopy during many of these interventional procedures. More recently, new technologies such as real-time echocardiography have further enhanced the performance of echocardiographic imaging guidance.
The added value of echocardiography during interventional procedures has been emphasised in the recently published American Society of Echocardiography recommendations for clinical practice, focusing on echocardiography guided interventions.1
It is noteworthy that these increasingly sophisticated catheter based procedures require a team approach, with the interventionalist and the echocardiographer speaking the same language. Both should have a good knowledge of the procedural requirements, which specific parameters to monitor, and what incremental diagnostic information echocardiography and/or fluoroscopy may provide during each step of the procedure.
This article discusses the use of echocardiography in the catheterisation laboratory during the most commonly performed percutaneous interventions, focusing on practical aspects. The role of echocardiography during electrophysiological procedures, or during pericardiocentesis, is not discussed in this article and …
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