Intracardiac Echo, Antalya | Prof. Dr. Umuttan Doğan

Intracardiac echocardiography is an imaging method in which a catheter with a small ultrasound probe at its tip is placed inside the heart. It is often shortened to ICE. The probe is not on the chest wall or in the gullet but directly inside a chamber of the heart, and the picture is taken from there. It is not a treatment but a way of guiding one. Its clearest practical consequence is this: where it is used, many procedures can be carried out without a general anaesthetic.

Three Ways of Looking at the Heart

Seeing inside the heart is essential during an interventional procedure. There are three ways of doing it, and each looks from a different distance.

An echo through the chest wall. This is the standard echocardiogram. The probe is placed on the chest. It is easy and causes no trouble, but the ribs and lung tissue lie in between, so the detail is limited.
An echo from the gullet. The probe is swallowed. Because the oesophagus runs just behind the heart, the picture is far clearer. In return it brings a gag reflex and the need to lie still.
Intracardiac echo. The probe is carried into the heart on a catheter. Nothing lies in between; the picture is taken directly.

What Is Intracardiac Echocardiography?

The catheter used is about as thick as the angiography catheters you may already have heard of. At its tip is a small probe that sends out ultrasound waves and receives them back.

The catheter is passed in through the vein in the groin and taken to the right atrium. By steering it from outside, the cardiologist changes the direction the probe is facing and brings different parts of the heart into view.

The picture is live: the movement of the catheters, a balloon inflating, a device opening, all followed as they happen. Colour Doppler also shows which way the blood is flowing and how fast.

Why Look from Inside the Heart?

X-ray imaging is the basis of interventional procedures, but it has an important limit: it does not show soft tissue. What appears on the screen is the shadow of catheters and devices; the wall of the heart, the valves and the partitions between the chambers do not appear.

Ultrasound does the opposite. It shows soft tissue, its thickness and its movement.

Used together, the cardiologist sees both where the instrument is and what the tissue around it is doing, at the same moment.

The Difference That Matters Most: Anaesthesia

This is the heading that changes most for the patient.

An echo from the gullet means swallowing the probe and lying still throughout. That usually means a general anaesthetic.

Where intracardiac echo is used, nothing goes into the gullet. The imaging comes through the same vein the procedure is being done through. Many procedures can therefore be completed under local anaesthetic with light sedation.

What that gives you is this: no waking-up period, none of the risks that come with a general anaesthetic, and the ability to speak to your cardiologist during the procedure.

This does not hold for every procedure. In some — repairing a leaking valve by catheter, for instance — an echo from the gullet is still the standard method and a general anaesthetic is needed.

Which Procedures Is Intracardiac Echo Used In?

Guiding the Crossing Between the Chambers

Procedures that need to reach the left atrium involve a controlled crossing of the wall that separates the two atria. The thickness and shape of that wall differ from person to person, and the aorta and the sac around the heart lie next to it.

Intracardiac echo shows exactly where the crossing should be made. The moment the needle tents the wall is seen on the screen.

Closing a Hole in the Heart

In ASD closure procedures, the size of the hole, whether there is enough tissue around it and how the device is sitting can all be assessed this way. Before the device is released, the picture confirms that it is seated securely.

Ablation Procedures

In atrial fibrillation ablation, whether the catheter is in contact with the tissue, whether the balloon is seated at the mouth of the vein and the state of the surrounding structures can all be followed.

Checking for Clot

Whether there is a clot in the left atrium has to be checked before the procedure. That check is usually made with an echo from the gullet; in suitable circumstances intracardiac echo can be used for it as well.

What Does the Picture Show?

The cardiologist watches a few concrete things on the screen throughout. Knowing them makes it clear why the method is used.

Where is the tip of the catheter? On X-ray only a shadow appears. On ultrasound you see which tissue the tip is touching.
Is there contact? In ablation the catheter has to touch the tissue. If it does not, the energy delivered achieves nothing.
Where is the wall being tented? When crossing to the left atrium, the point where the needle pushes the wall appears on screen like a tent, and it becomes clear whether it is in the right place.
Is the device seated? In closure procedures, whether the discs are resting against the wall is seen before the device is released.
Is anything still leaking? Colour Doppler shows straight away whether flow is still crossing.
Is fluid collecting? Even the smallest collection in the sac around the heart is noticed.

Intracardiac echocardiography provides continuous feedback during the procedure, and the next step is taken in the light of it.

Noticing a Complication Early

This is the least known and most valuable part of the page.

One of the rare but important problems of interventional procedures is fluid collecting between the heart and the sac around it. If it is not noticed early, it can affect the circulation.

Because intracardiac echo stays open on the screen throughout, that collection can be seen while it is still very small. The problem is picked up before it grows, and whatever is needed is done in time.

So the method does not only guide the procedure; it also acts as a safety eye while it is under way.

How Is It Done?

Intracardiac echo is not a separate procedure; it is part of the one that is planned.

A second sheath is placed in the groin vein, alongside the route opened for the procedure itself.
The imaging catheter is advanced through that sheath to the right atrium.
The cardiologist steers the catheter to take the views needed and keeps them on screen throughout.
When the procedure is finished the catheter is withdrawn and pressure is applied to the access site.

There is no separate appointment, no separate preparation and no second procedure.

What Intracardiac Echo Cannot Do

A balanced picture calls for these as well.

It needs an extra route in. A second access point is opened in the groin.
It shows distant structures less well. With the probe in the right atrium, the furthest parts of the heart are not always seen with the same clarity.
It is not needed in every procedure. In straightforward cases the X-ray picture is enough and an extra catheter adds nothing.
In some procedures an echo from the gullet is still the standard. Interventions that call for detailed assessment, such as valve repair, belong in that group.

Which imaging method is used is decided by weighing the type of procedure and your own situation together.

How Intracardiac Echo and IVUS Differ

Both take an ultrasound picture with a probe on the tip of a catheter, which is why they are often confused. The difference is where the probe goes.

IVUS (intravascular ultrasound): the probe goes inside a coronary artery. It shows the wall of the vessel, the plaque and the calcium on a millimetre scale. Its subject is an artery.
Intracardiac echocardiography: the probe is placed in a chamber of the heart. It shows the partitions, the valves, the walls and the chambers. Its subject is the structure of the heart.

The catheters differ too. An IVUS catheter is thin enough to enter a coronary artery and images a very short distance in great detail. An intracardiac echo catheter is thicker and is built to see a few centimetres away.

Neither can stand in for the other. IVUS belongs to coronary procedures, intracardiac echocardiography to procedures inside the heart. The same patient may have both, in different procedures.

What Are the Possible Risks?

Bruising, bleeding or injury to the vessel at the access site
Temporary changes in rhythm as the catheter is advanced
Rarely, injury to a vessel or to the wall of the heart
A short addition to the length of the procedure

These are weighed against what the imaging contributes to the procedure, and they are discussed at the consultation beforehand.

Intracardiac Echo in Antalya

Prof. Dr. Umuttan Doğan is a cardiologist working in the interventional treatment of heart defects, in valve procedures and in ablation for rhythm disorders; intracardiac echocardiography is one of the methods that guide these procedures. They are carried out in the catheter laboratory at Antalya American Hospital.

If an interventional procedure has been suggested to you and you are wondering how it will be guided, you can be seen at the clinic in Konyaaltı with the results you already have. For imaging inside an artery see IVUS, and for the other methods the diagnosis and imaging page. You will find his background and contact details on their own pages.

Frequently Asked Questions

Is intracardiac echo a separate procedure?

No. It is part of the planned procedure and is done in the same session, through the same area of the groin. There is no separate appointment and no second procedure; it adds only a short time.

How does it differ from an echo through the gullet?

In an echo from the gullet the probe is swallowed and the heart is seen from behind; because of the gag reflex and the need to lie still, a general anaesthetic is usually given. In intracardiac echo the probe is carried into the heart on a catheter and nothing goes into the gullet.

Does using this method mean I will not be put to sleep?

For many procedures local anaesthetic and light sedation are enough. It depends on the procedure, though. In some, an echo from the gullet is still the standard method and a general anaesthetic is needed. What will be used in your case is discussed beforehand.

Isn’t it a risk to put a catheter inside the heart?

The catheter used is similar to those already used in interventional procedures and is advanced along the same route. It has risks of its own, but they are limited ones added to the procedure as a whole. Against them, the imaging helps the procedure to be carried out with more control.

Is intracardiac echo used in every procedure?

No. In straightforward procedures the X-ray picture is enough and an extra catheter adds nothing. The method comes into play where the left atrium has to be reached, where a device is being placed, or where soft tissue needs to be seen in detail.

The information on this page is for general guidance and does not replace a consultation. Decisions about diagnosis and treatment are made by your doctor after assessing your own situation.