Intracardiac echocardiography with ultrasound probe placed in the upper left pulmonary vein to guide left atrial appendage closure: First description

Intracardiac echocardiography (ICE) has become an effective alternative to trans-esophageal echocardiography (TEE) as a guidance during interventional procedures for structural heart diseases, allowing to proceed under conscious sedation. To guide percutaneous left atrial appendage (LAA) closure, the ICE probe is usually placed in the right atrium, in the pulmonary artery or in the left atrium (LA); however, the views from the right atrium or the pulmonary artery are often suboptimal, debarring a complete visualization of the LAA and the surrounding structures, whereas the LA location requires trans-septal puncture, may provoke LA wall mechanical stimulation and is often associated with unstable position of the ICE probe. In our case, after a second trans-septal puncture, the ICE probe was placed in the upper left pulmonary vein; this was safely performed and provided an optimal imaging of the LAA, comparable to that obtained by TEE, thus warranting an adequate guide during all procedural steps.