An Initial Experience in the Use of 3D ICE for the Periprocedural Guidance of Percutaneous ASD Closure at a Tertiary Pediatric Center.

Abstract

The dynamic, multiplanar nature of the atrial septum can make ASDs challenging to characterize with 2D imaging. 3D imaging instantly profiles defect(s) in a single, en face view. 2D ICE-guided ASD device closure in the pediatric population has been reported, but 3D ICE-guided closure has not, and the correlation of 3D ICE measurements with fluoroscopic balloon-sizing diameter (BSD) remains unstudied. We describe our initial experience with 3D ICE in the periprocedural evaluation of percutaneous ASD closure. Consecutive patients undergoing percutaneous ASD closure at our institution from July 2022 to July 2023 were included. BSD was measured by the primary interventionalist, and non-invasive ASD dimensions were measured by two investigators intra-procedurally. Correlations were assessed between maximal BSD versus maximal ASD diameter by 2D (TEE, ICE) and 3D modalities (TEE, ICE). Fifteen patients underwent percutaneous ASD closure, and 11/15 (73%) underwent ICE (2D and 3D). Three cases omitted ICE due to equipment unavailability, and one due to inadequate imaging windows related to spinal rods. 10 of 11 patients also underwent TEE, while one had ASD closure by fluoroscopy and ICE alone due to provider preference. Six of ten TEEs (60%) included 3D imaging based on weight cut-off. The median age of ICE patients was 6 years (IQR: 7.5), with a median weight of 20.5 kg (IQR: 35.8). 3D ICE was attempted in all; image quality assessed as 'fair' or 'good' by two reviewers in 8/11 patients. Intraprocedural imaging correlated strongly with BSD [3D ICE vs. BSD (n = 7): ICC = 0.915, p < 0.001)]. Median pre-device deployment evaluation time by ICE was 14 min (IQR: 8.25), and 5 min (IQR: 3.0) post-device deployment. 3D ICE is a viable adjunctive imaging tool for guiding ASD closure procedures within the pediatric cohort, offering safety, efficiency, and congruence with established imaging modalities. Maximal ASD dimensions by 3D ICE correlate well with BSD.