VIDEO: The evolving roles of TEE and ICE in structural heart interventions
Northwestern Medicine in Chicago has a high-volume structural heart program and has pioneered new technologies to aid procedural guidance in the cath lab. To find out more on recent trends and technology advancements in structural heart imaging, Cardiovascular Business spoke with Akhil Narang, MD, director of the echocardiography laboratory at Northwestern Medicine. He is also an assistant professor of medicine at Northwestern University Feinberg School of Medicine and current American Society of Echocardiography (ASE) board member.
Narang emphasized the critical role of transesophageal echo (TEE) and growing role for intracardiac echo (ICE) in guiding structural heart interventions. He spoke on these advances at the ASE 2023 meeting.
Complementary role of ICE and TEE in structural heart procedures
One of the key topics of discussion at ASE 2023 was the advancement of ICE imaging with 3D/4D, high-resolution imaging. ICE has gained prominence in the field of electrophysiology, especially in left atrial appendage (LAA) occlusion, and is now finding other applications in structural heart procedures. The technology offers high-quality 2D and 3D imaging, making it a valuable tool for mitral and tricuspid valve interventions.
Narang said TEE has limitations in being able to image the tricuspid valve, especially when the TEE probe needs to be positions for transgastric views and images through the diaphragm. But, he said ICE can image patients where TEE imaging is not possible or suboptimal because the catheter is placed inside the heart. This can enable clipping and replacement valve procedures that otherwise could not be performed. He said ICE will likely play a bigger role once the FDA clears new transcatheter tricuspid valve devices working their way towards regulator review.
Additionally, ICE may obviate the need for intubation and an anesthesiologist if TEE is not used, presenting advantages for both patients and clinicians.
"There are a number of patients in which TEE might not be feasible for challenges in esophageal anatomy or patient anatomy and ICE might be preferable. We've used it a number of times in the tricuspid valve space increasingly, and I think it could be a nice adjunct to TEE. ICE has great frame rates for the 2D imaging, but with the 3D imaging, you lose some of the frame rates and then the color degrades a little bit as well," Narang explained.