Three-dimensional (3D) intracardiac echo (ICE) generates high-quality, near-field images of cardiac structures and holds potential to emerge as a complement or alternative to transesophageal echocardiography (TEE) for intraprocedural guidance of structural heart interventions, according to a position statement published in JACC: Cardiovascular Imaging and discussed as part of the New York Valves Structural Heart Summit 2024.

The statement, authored by Gilbert H.L. Tang, MD, MSc, MBA, FACC, and Syed Zaid, MD, et al., provides standardized guidance on the indication and utilization of 3D-ICE in various structural heart procedures. Topics of note include fundamentals of 3D-ICE imaging, as well as workflow recommendations specific to ICE-guided structural heart procedures like transeptal puncture, device closure of intracardiac structures, and transcatheter mitral and tricuspid valve interventions.

The authors also explore current challenges and future directions for 3D-ICE imaging, specifically highlighting the importance of training requirements to ensure operator efficiency and support the expansion of clinical applications in the future. Key training components outlined by Tang, Zaid and colleagues include a didactic program, hands-on-training, clinical experience and minimal procedural volume. They add that “future research and technological advancement” are also needed as 3D-ICE moves forward.