Case Reports
Intracardiac echocardiography using the AcuNav ultrasound catheter during percutaneous balloon mitral valvuloplasty*

https://doi.org/10.1067/mje.2002.126771Get rights and content

Abstract

During the past 10 years, there has been a trend toward and an interest in the use of catheter-based interventions to perform procedures that were once only approached surgically. The problem with the catheter-based approach has been procedure-related complications. Improved imaging of cardiac structures while undertaking interventional procedures may help to prevent or allow for early identification of these complications. Transesophageal echocardiography has been used during catheter-based procedures as a guide, and has both advantages and disadvantages. Intracardiac echocardiography is a relatively new imaging technique that also provides an enhanced view of cardiac structures and may also allow for the safe and efficient performance of catheter-based procedures. We report the first case of successful percutaneous balloon mitral valvuloplasty done under ultrasound guidance using an intracardiac echocardiography catheter (10F, 5-10 MHz) (Acunav). The strengths and weaknesses of this approach are described and compared with transesophageal echocardiography and older intracardiac echocardiography devices. (J Am Soc Echocardiogr 2002;15:1533-7.)

Section snippets

Case report

A 47-year-old woman with a medical history significant for a heart murmur known since childhood was referred to the North Shore University Hospital echocardiography laboratory for TTE imaging to evaluate symptoms of progressively worsening dyspnea. On cardiac examination the murmur was noted to be a grade II/VI, low-pitch, diastolic murmur auscultated at the cardiac apex. TTE was performed showing severe rheumatic mitral stenosis with a calculated mitral valve area of 0.7 cm2 using the pressure

Discussion

The use of PBMV for the treatment of patients with pure rheumatic mitral stenosis with a favorable valvuloplasty score has become the treatment of choice. Prior PBMV procedures have relied heavily on fluoroscopy and TEE for imaging. We report the case of the first patient to undergo PBMV using ICE guidance with a 10F, 5- to 10-MHz ultrasound transducer.

The catheter is a new low-frequency (5- to 10-MHz) ultrasound transducer that has many advantages over older types of intracardiac ultrasound

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*

Reprint requests: Judy Mangion, MD, Echocardiography Laboratory, North Shore University Hospital, 300 Community Dr, Manhasset, NY 11030.

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Copyright © 2002 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.