Cardiologists at The Dutch university hospital Maastricht UMC+ are the first in the Benelux to use a new ultrasound technique that generates three-dimensional images from inside the heart during heart valve procedures. According to the hospital, 3D intracardiac echocardiography (3D ICE) provides detailed imaging during interventions and could make treatment less invasive for certain patients. In some cases, it may also eliminate the need for general anaesthesia.
An increasing number of heart valve conditions can be treated using a catheter inserted through a vein in the groin and guided towards the heart, avoiding the need for open-heart surgery. During these procedures, interventional cardiologists and cardiac imaging specialists work closely together, with accurate imaging essential to performing the intervention safely and precisely.
Until now, imaging during these procedures has largely relied on transoesophageal echocardiography (TEE), in which an ultrasound probe is inserted into the oesophagus. This generally requires patients to undergo general anaesthesia.
Imaging from inside the heart
With 3D intracardiac echocardiography, a miniature ultrasound probe is guided through a vein in the groin directly into the heart. From inside the heart chambers, the probe produces detailed three-dimensional images of the heart valve.
Over the past year, Maastricht UMC+ has been the first centre in the Benelux (Belgium, Netherlands, Luxembourg) to use the technology during procedures involving the tricuspid valve, which is located between the right atrium and right ventricle.
According to the hospital, 3D ICE offers particular advantages in procedures involving this valve. Its anatomical position can make the tricuspid valve difficult to visualise properly using transoesophageal ultrasound. Imaging from inside the heart provides a clearer view, enabling the interventional cardiologist and imaging cardiologist to immediately assess whether a clip has correctly grasped the valve leaflets.
The first experiences with the technology have been promising, according to Maastricht UMC+. Patients have already been treated for whom a procedure using transoesophageal imaging alone would not have been possible. The hospital will continue to investigate the added clinical value of 3D ICE in everyday practice over the coming years.
Broader applications
Maastricht UMC+ is now also exploring the use of 3D intracardiac echocardiography in procedures involving the mitral valve. If the technique proves suitable for these interventions as well, transoesophageal ultrasound could potentially be avoided in some patients.
This could mean that general anaesthesia is no longer necessary for part of this patient population, making treatment less demanding, particularly for older and more vulnerable patients.
According to Sebastian Streukens, interventional imaging cardiologist and clinical head of echocardiography at Maastricht UMC+, high-quality imaging is a key factor in determining what can be achieved during heart valve interventions. He expects the new technology could help physicians treat more patients, including some for whom treatment was previously not possible.
Further research will have to establish the clinical benefits of 3D ICE and determine to what extent the technology can reduce the burden of heart valve procedures on patients.
Pieter Vriesendorp, interventional cardiologist at Maastricht UMC+, also emphasises the importance of collaboration during complex heart valve procedures. According to Vriesendorp, the new imaging capabilities allow the clinical team to make better-informed decisions during an intervention, with the aim of achieving the best possible outcome for the patient.
Miniature ultrasound probe
The technology used for 3D ICE builds on the development of increasingly compact ultrasound systems. Philips for example introduced its VeriSight Pro 3D ICE catheter in Europe in 2025 after the technology had previously been used in the United States. The device incorporates a miniature ultrasound probe, approximately three millimetres in diameter, into the tip of a steerable catheter.
Once positioned inside the heart, the probe can provide real-time 2D and 3D images. This gives physicians a direct view of cardiac anatomy from within the heart chambers themselves and supports decision-making during structural heart and electrophysiological procedures.
One of the potential advantages is that intracardiac imaging can reduce reliance on transoesophageal echocardiography. Because TEE often requires general anaesthesia, replacing it in suitable procedures could reduce the burden on patients and potentially make treatment and recovery more efficient.
The technology also enables physicians to visualise medical devices while they are being positioned and assess the results of an intervention from a single access point. Features such as xPlane allow two imaging planes to be viewed simultaneously, while iRotate enables the viewing direction to be changed digitally without physically repositioning the catheter.
