Transcatheter aortic valve replacement with intracardiac echocardiography from the right internal jugular vein

Abstract

Transesophageal echocardiography (TEE) is a useful imaging modality to guide transcatheter aortic valve replacement (TAVR). The limitations of TEE include the need for general anesthesia (GA) and endotracheal intubation. In Europe, TAVR under local anesthesia (LA) is usually performed without TEE. An intracardiac echocardiography (ICE) catheter may be used as an alternative to TEE, but the catheter is usually inserted from the femoral vein (FV-ICE). There are some reports of TAVR with FV-ICE; however, there are no reports of ICE inserted from the right internal jugular vein (JV-ICE). In the first case of its kind, we successfully performed TAVR under LA with JV-ICE. JV-ICE allows for the evaluation of perioperative hemodynamics, measurement of the aortic valve complex, and assessment of major complications during the procedure without interference from the operator or fluoroscopes; these represent a distinct advantage over TEE, transthoracic echocardiography, and FV-ICE. Moreover, there is no need for the echocardiologist to use maximal barrier precautions; the catheter can be operated in the standing position, like TEE; and operability is higher than that with FV-ICE. TAVR with JV-ICE is a promising alternative to TAVR under GA with TEE and TAVR under LA with FV-ICE.