How to do Intracardiac Echocardiography ICE - 10 Basic Views to Master

Above video demonstrate the10 Basic Views to master in Intracardiac Echocardiography also known as ICE, presented in simple form with real time images labeled with important structures. Home view is usually the first view when we insert intra-cardiac echo catheter or ICE catheter into right atrium. 

Types of Intracardiac Echocardiography: 

There are two types of ICE - phased array and radial.
○ Phased array: more common as it creates a view that is easier to interpret as it resembles a TTE or TEE.
○ Radial ICE: greater resolution, but is more difficult to interpret and is best for discriminating near-field structures and therefore requires transseptal puncture to visualize left heart structures.

Process:

● Insert catheter through the femoral vein up through the IVC to the right atrium (most commonly), “the home base” for the ICE catheter. The catheter can also be inserted via the right IJ or left subclavian and then through the SVC however this will give “upsidedown” images; this method is preferred by some who wish to avoid entanglement/interaction with other wires placed through the IVC.

 
● Since the pulmonary veins are of primary importance in ablation procedures, to gain access to to the LA where the PVs insert, a transseptal puncture of the interatrial septum is performed. Prior to performing this puncture, it is crucial to evaluate for the presence of an intracardiac thromboemboli in the left atrium that could then potentially pass through the puncture and embolize outside of the heart, for instance to the brain. Potential for thrombo-emboli would be seen as a spontaneous echographic contrast, also called “smoke (1) and (2)” Essentially, SCE appears as hyperdense substance where it should not be present (i.e. in the chamber of the left atrium which should appear hypodense). If SCE is detected, a trans-septal puncture should not be performed.