Graziano U., Esposito P., Ferraiuolo S., Mandato C., Paladini R., Serio V., Spagnuolo F. VAD implant localization by Trans-Thoracic U.S.
Children Hospital “Santobono-Pausilipon” - Naples Abstract
Tip positioning at cavo-atrial junction is mandatory for a correct VAD implantation. This is the paramount tip location: catheter direction is parallel to vein axis reducing endothelial contact; moreover blood turbolences are minimal at that position and so are vascular device fluctuation.
During XX century several implantation control system were used: antropometric landmarks, intra-procedural fluoroscopy, post-procedural X-Ray and finally the intra-cavitary ECG which is still considered the most effective method in term of benefit-cost ratio.
Trans Esophageal Ecography (TEE) would be the gold standard of catheter tip positioning, in relation of the minimal distance between intraesophageal echographic probe and the right atrium and for the absence of patient/operators exposition to radiation. Otherwise procedure invasivity has limited TEE availment in clinical practice.
Trans thoracic ecography (TTE) should be considered as a possible alternative in pediatric patients, mainly of younger age as a result of the less thickness of chest wall. Some of the advantages which have to be taken into account are: great handiness, intraprocedural utilization, favourable benefit-cost ratio. Again TTE tecnique needs specific equipment and staff training.
Authors reported their pilot experience on intra procedural VAD location by TTE, in infant and children. Ultrasound scans were: 2° intercostal space-left sternal border, short axis; subcostal scan for long bicaval view. Both tecniques were enriched by CEUS (Contrast Enanched Ultrasound).
