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. 2001 Nov;86(5):e11. doi: 10.1136/heart.86.5.e11

Transseptal left heart catheterisation guided by intracardiac echocardiography

T Szili-Torok, G Kimman, D Theuns, J Res, J Roelandt, L Jordaens
PMCID: PMC1729980  PMID: 11602562

Abstract

OBJECTIVE—To develop a novel approach of transseptal puncture guided by intracardiac echocardiography and to assess its efficacy.
METHODS—Transcatheter intracardiac echocardiography with a 9 MHz rotating transducer was performed to guide transseptal puncture in 12 patients (mean age 43.1 years, range 31-68) who underwent radiofrequency catheter ablation of left sided accessory pathways. Initially, the echocardiography and transseptal catheters were placed adjacent to each other in the superior vena cava and were withdrawn to the level of the fossa ovalis.
RESULTS—The successful puncture site was associated with visualisation of the fossa ovalis (12 patients, 100%) and the aorta (12 patients, 100%), tenting of the fossa (six patients, 50%), penetration of the needle visualised by the ultrasound catheter (12 patients, 100 %), and echocardiographic contrast material applied in the left atrium (12 patients, 100%). The characteristic jump of the needle onto the fossa ovalis was observed simultaneously with fluoroscopy and intracardiac ultrasound (12 patients, 100%). All procedures were successful. There were no complications associated with the transseptal procedure.
CONCLUSIONS—Intracardiac echocardiography is feasible to guide transseptal puncture. The optimal puncture site can be assessed by simultaneous detection of the characteristic downward jump of the transseptal needle onto the fossa ovalis by intracardiac ultrasound and fluoroscopy.


Keywords: intracardiac echocardiography; transseptal catheterisation

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Figure 1  .

Figure 1  

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(A, left) Anteroposterior fluoroscopy view of the dilator sheath (double arrows) and the intracardiac ultrasound catheter at the time of the picture in panel B. (B, right) View of interatrial septum and fossa ovalis with intracardiac echocardiography. The double arrow is pointing to the dilator sheath and the intracardiac echocardiography probe. The dilator sheath is moving in the direction of the fossa ovalis from the contralateral side of the aortic valve. AoV, aortic valve; LA, left atrium; RA, right atrium.

Figure 2  .

Figure 2  

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Tenting of the fossa can become very characteristic, as it in this case.

Figure 3  .

Figure 3  

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Image of the fossa ovalis after transseptal puncture. The transseptal sheath is penetrating the membrane of the interatrial septum.

Figure 4  .

Figure 4  

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A rare case: a double membrane is clearly visible in the fossa ovalis. Next to the left atrium the aortic arch is visualised. Ao, aorta; CT, crista terminalis.

Figure 5  .

Figure 5  

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Small fossa ovalis detected by intracardiac echocardiography. In this patient the size of the fossa ovalis was 4.8 mm.

Figure 6  .

Figure 6  

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(A, left) The heart at the time of closure of the tricuspid valve. The morphology of the valve in the left side of the heart may be mistaken for the mitral valve; however, the location of the chambers and the asynchronous closure of the valves clearly indicates that this is the aortic valve. (B, right) The same chambers 400 ms later at the time of closure of the aortic valve. LV, left ventricle; MV, mitral valve; RV, right ventricle; TS, transseptal sheath (the dilator sheath that is pointing towards the membranous right atrial wall adjacent to the aorta at the level of aortic valve).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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