Efficiency is the ubiquitous hospital edict, and interventional cardiologists (and some radiologists) are responding by incorporating the most efficient, most reliable and safest imaging technologies into cardiac cath lab work. Whether imaging is pre-procedural or present in the lab while the cardiac work is underway, excellent images are the linchpin to repairing everything from atrial septal defects (ASDs) in children to arterial lesions in adults.

New facilities are considering positioning complementary imaging technology — such as magnetic resonance imaging — next to the cath lab, possibly and eventually within the lab. As interventional cardiologists and their patients benefit from imaging advances, issues remain to be dealt with, including better resolution and image integration. Nevertheless, cutting-edge cardiac cath lab technology is here and now, not down an uncertain road. And predictably, less radiation exposure is a driver in and around the cath lab.

Intracardiac echo
Children’s Memorial Hospital (Chicago) is using intracardiac echocardiography (ICE) with its thin catheters to take dynamic pictures inside young patients’ hearts. The technology is favored for a number of reasons.

“Children can’t have transesophageal echocardiogram (TEE) without having general anesthesia, David Wax, pediatric cardiologist at Children’s Memorial Hospital says. “They won’t sit still having a big hose put down their throat. Even adults find it very unpleasant. And it’s uncomfortable the next day. So [ICE is preferable] from a perspective of being able to avoid anesthesia and the cost of anesthesia.”

The whole circumstance, according to Wax, is sterile and some doctors, Wax included, prefer the approach because they are controlling the echo as they’re doing the procedure.

For young adults, for instance, intracardiac echo is used in cases where patients have strokes and are found to have an opening in their heart similar to an atrial septal defect. The condition, patent foramen ovale (PFO), involves a flap that does not seal over and sometimes remains patent. It is believed that PFO allows the passage of small clots from the veins in the leg, for example, as they pass up to the heart. They would otherwise go to the lungs and be filtered out there.

Please refer to the March 2003 issue for the complete story. For information on article reprints, contact Martin St. Denis