Three-dimensional intracardiac echocardiography (3D ICE) with wide azimuthal elevation is a novel technique performed for assessment of cardiac anatomy and guidance of intracardiac procedures, being able to provide unique views with good spatial and temporal resolution. Complications arising from this invasive procedure and the value of 3D ICE in the detection and diagnosis of acute cardiovascular pathology are not comprehensively described. This case illustrates a previously unreported iatrogenic complication of clot displacement from the intra-vascular sheath upon insertion of a 3D ICE catheter and the value of 3D ICE in immediate diagnosis of clot in transit through the heart with pulmonary embolism. We conducted a translational study of 3D ICE with wide azimuthal elevation to guide implantation of a left ventricular assist device (Impella CP®) in eight adult sheep. A large-bore 14 Fr central venous sheath was used to enable right atrial and right ventricular access for the intracardiac catheter. Insertion of the 3D ICE catheter was accompanied by a sudden severe cardiorespiratory deterioration in one animal. 3D ICE revealed a large highly mobile mass within the right heart chambers, determined to be a clot-in-transit. The diagnosis of pulmonary clot embolism resulting from the retrograde blood entry into the large-bore sheath introducer, rapid clot formation and consequent displacement into venous circulation by the ICE catheter was made. The sheep survived this life-threatening event following institution of cardiovascular support allowing completion of the primary research protocol. This report serves as a serious warning to the researchers and clinicians utilizing long large-bore sheath introducers for 3D ICE and illustrates the value of 3D ICE in detecting clot-in-transit within right heart chambers.

中文翻译：

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三维心内超声心动图和肺栓塞。


具有宽方位角仰角的三维心内超声心动图（3D ICE）是一种用于评估心脏解剖结构和指导心内手术的新技术，能够提供具有良好空间和时间分辨率的独特视图。这种侵入性手术引起的并发症以及 3D ICE 在急性心血管病理检测和诊断中的价值尚未得到全面描述。该病例说明了插入 3D ICE 导管后血栓从血管内鞘移位的先前未报告的医源性并发症，以及 3D ICE 在立即诊断通过心脏的血栓并伴有肺栓塞时的价值。我们对具有宽方位角仰角的 3D ICE 进行了转化研究，以指导在八只成年羊中植入左心室辅助装置 (Impella CP®)。使用大口径 14 Fr 中心静脉鞘使心内导管能够进入右心房和右心室。插入 3D ICE 导管后，一只动物的心肺功能突然严重恶化。 3D ICE 显示右心室内有一个巨大的高度移动的肿块，确定为转运中的血栓。诊断为肺血栓栓塞，原因是血液逆行进入大口径鞘管导引器，快速形成血栓，随后通过 ICE 导管进入静脉循环。在心血管支持机构完成主要研究方案后，这只羊在这次危及生命的事件中幸存下来。 该报告对使用长大口径鞘导引器进行 3D ICE 的研究人员和临床医生提出了严重警告，并说明了 3D ICE 在检测右心腔内转运血栓方面的价值。