Figure 2.
Atrial septal puncture procedure sequence. (A) Baseline transverse slice imaged in real-time. Ao=aorta, RA=right atrium, LA=left atrium, FO=fossa ovalis (white arrow), PV=pulmonary vein. (B) The modified “active” ASP needle (green) can be seen tenting the interatrial septum at the level of the fossa ovalis. (C) The needle tip has entered into the LA. (D) A floppy-tipped 0.018” wire is advanced through the needle into the LA and subsequently left atrial appendage (LAA). It has coupled with the needle signal and therefore appears green. The dilator sheath tip susceptibility marker can be seen abutting the RA side of the septum (yellow arrow).