Intracardiac Echocardiography vs AoG/CCT to Guide Transcatheter Closure of Patent Ductus Arteriosus

Intracardiac echocardiography (ICE) was found to be comparable with aortography or cardiac computed tomography (AoG/CCT) in providing accurate pulmonary artery side diameter (PA-D) of the patent ductus arteriosus (PDA) and may be a safe alternative to guide transcatheter closure of PDA (TC-PDA), according to a study published in the Journal of Interventional Cardiology.

The following PDA size parameters were compared when measured with ICE vs AoG/CCT in 23 patients (13 children and 10 adults; median age, 17) who underwent TC-PDA: PA-D, PA length, and aortic side diameter (Ao-D) of PDA. The demographics, fluoroscopic time, contrast volume, and complications of the TC-PDAs were also examined in adult patients with or without ICE guidance (n=10; median age, 62.8; 5 women and n=16; mean age, 64.1; 11 women, respectively).

There were strong correlation and agreement between ICE and AoG/CCT measurements of PA-D (r = 0.985; bias −0.077 to 0.224), and moderate to poor correlation and agreement for measurements of PA length (r = 0.653; bias −0.491 to 3.065) and Ao-D (r = 0.704; bias 0.738 to 4.732). All patients underwent successful TC-PDA with ICE guidance that allowed continuous monitoring of the entire process.

TC-PDA required significantly lower or no contrast agent volume when performed with vs without ICE guidance. Age and parameters including PDA size, pulmonary to systemic blood flow ratio, and fluoroscopic time were comparable between the 2 groups.

Study limitations include discrepancies in institutional CCT acquisition protocols, and the fact that all patients had Krichenko type A PDAs.

“ICE was comparable to aortography or CCT in providing accurate measurements of PA side diameter for TC-PDA,” noted the researchers. “ICE may be a safe alternative to conventional imaging as a guide for TC-PDAs and can be useful for patients with large PDA, renal dysfunction, or contrast allergy.”

Reference

Yoshimoto H, Yasuto M, Inoue T, et al. Intracardiac echocardiography as a guide for transcatheter closure of patent ductus arteriosus. J Interv Cardiol. 2020;2020:5147193. doi: 10.1155/2020/5147193