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Echocardiography-Guided Interventions

2009; Elsevier BV; Volume: 22; Issue: 3 Linguagem: Inglês

10.1016/j.echo.2008.12.013

1097-6795

Frank E. Silvestry, Richard E. Kerber, Michael M. Brook, John D. Carroll, Karen M. Eberman, Steven A. Goldstein, Howard C. Herrmann, Shunichi Homma, Roxana Mehran, Douglas L. Packer, Alfred F. Parisi, Todd Pulerwitz, James B. Seward, Teresa S.M. Tsang, Mark A. Wood,

Cardiac Structural Anomalies and Repair

Continuing Medical Education activity for “Echocardiography-Guided Interventions”Accreditation Statement:The American Society of Echocardiography (ASE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing International recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The ASE is committed to resolving all conflict of interest issues, and its mandate is to retain only those speakers with financial interests that can be reconciled with the goals and educational integrity of the educational program. Disclosure of faculty and commercial support sponsor relationships, if any, has been indicated.Target Audience:Participation should include individuals from the fields of echocardiography, interventional cardiology, electrophysiology, cardiac sonography, and cardiac surgery, as well as medical residents, fellows, and students.Learning Objectives:After reading this article, participants should be able to: (1) Assess the strengths and weaknesses of each echocardiographic modality (transthoracic echocardiography, transesophageal echocardiography, intracardiac echocardiography, 3-dimensional echocardiography) in guiding interventional cardiologic and electrophysiologic procedures. (2) Use echocardiography to guide interventional procedures. (3) Recognize echocardiographers' role in catheterization and electrophysiology laboratories.Author Disclosures:Frank E. Silvestry is a consultant for Biosense Webster (Diamond Bar, CA), formerly Siemens Medical Systems (Erlangen, Germany). John D. Carroll is a consultant and lecturer for and a recipient of royalties from Philips Healthcare (Andover, MA), a consultant for Biosense Webster, and a consultant for W. L. Gore & Associates (Newark, DE). Howard C. Herrmann is a consultant for Biosense Webster and AGA Medical (Plymouth, MN) and has received research funding from Edwards Lifesciences (Irvine, CA), Evalve (Menlo Park, CA), and W. L. Gore & Associates. Douglas L. Packer has received research support from Siemens Acuson (Mountain View, CA), is a past advisory board member for Siemens Acuson, and is a current scientific advisory board member for Siemens. Richard E. Kerber, Michael M. Brook, Karen M. Eberman, Steven A. Goldstein, Shunichi Homma, Roxana Mehran, Alfred F. Parisi, Todd Pulerwitz, James Bernard Seward, Teresa S. M. Tsang, and Mark A. Wood have no disclosures to report. Estimated Time to Complete This Activity: 1 hour A major advantage of echocardiography over other advanced imaging modalities (magnetic resonance imaging, computed tomographic angiography) is that echocardiography is mobile and real time. Echocardiograms can be recorded at the bedside, in the cardiac catheterization laboratory, in the cardiovascular intensive care unit, in the emergency room—indeed, any place that can accommodate a wheeled cart. This tremendous advantage allows for the performance of imaging immediately before, during, and after various procedures involving interventions. The purpose of this report is to review the use of echocardiography to guide interventions. We provide information on the selection of patients for interventions, monitoring during the performance of interventions, and assessing the effects of interventions after their completion. In this document, we address the use of echocardiography in commonly performed procedures: transatrial septal catheterization, pericardiocentesis, myocardial biopsy, percutaneous transvenous balloon valvuloplasty, catheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO), alcohol septal ablation for hypertrophic cardiomyopathy, and cardiac electrophysiology. A concluding section addresses interventions that are presently investigational but are likely to enter the realm of practice in the very near future: complex mitral valve repairs, left atrial appendage (LAA) occlusion devices, 3-dimensional (3D) echocardiographic guidance, and percutaneous aortic valve replacement. The use of echocardiography to select and guide cardiac resynchronization therapy has recently been addressed in a separate document published by the American Society of Echocardiography and is not further discussed in this document. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures.