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Mohammad A, Truong H, Abudayyeh I. Patent Foramen Ovale Embryology, Anatomy, and Physiology. Cardiol Clin 2024; 42:463-472. [PMID: 39322337 DOI: 10.1016/j.ccl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Patent foramen ovale (PFO) is a common finding in the general population but may lead to serious conditions such as stroke from paradoxical embolism and platypnea orthodeoxia. A thorough understanding of the interatrial septal anatomy along with its assessment by different imaging modalities is critical in performing safe transcatheter PFO closure. Investigating the anatomy and right heart to left heart flows using transesophageal echocardiography or intracardiac echocardiography imaging must be done before undertaking closure of a PFO.
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Affiliation(s)
- Adeba Mohammad
- Cardiology Department, Loma Linda University Health, 1234 Anderson Street, Loma Linda, CA 92354, USA
| | - HuuTam Truong
- VA Loma Linda Healthcare System, 11201 Benton Street, Loma Linda, CA 92354, USA
| | - Islam Abudayyeh
- VA Loma Linda Healthcare System, Charles Drew University, 11201 Benton Street, Loma Linda, CA 92354, USA.
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Salghetti F, Sieira J, Chierchia GB, Curnis A, de Asmundis C. Recognizing and reacting to complications of trans-septal puncture. Expert Rev Cardiovasc Ther 2017; 15:905-912. [PMID: 29161923 DOI: 10.1080/14779072.2017.1408411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The transseptal puncture (TSP) enables access to the left heart, through the fossa ovalis (FO), both in electrophysiology and in cardiac interventional procedures. TSP is usually safe in experienced hands. Sometimes TSP can be technically demanding and carries the risk of severe complications in approximately 1%. While performing a TSP, every effort should be taken in order to avoid complications. In the event of complications, prompt recognition and reaction are essential and a combined 'heart-team' management may be the most effective approach. Areas covered: Main TSP-related complications are cardiac tamponade, aortic root puncture, embolic stroke, transient ST elevation of inferior leads and iatrogenic atrial septal defect. A challenging TSP may be expected in presence of difficult IAS-FO anatomies, previous TSP, IAS occluder device and previous IAS surgical repair. Use of echo imaging and special needles (ie., radiofrequency needle and J-shaped guidewire) may avoid TSP-related complications in difficult settings. Expert commentary: Some tools are available to help minimize the risks of TSP. However, their availability might be limited. To increase safety of TSP, an adequate training of physicians, identification of patients in whom it might be difficult and a prompt recognition of complications seem to be the most important background.
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Affiliation(s)
- Francesca Salghetti
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium.,b Division of Cardiology , Spedali Civili Hospital, Università degli Studi di Brescia , Brescia , Italy
| | - Juan Sieira
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Gian-Battista Chierchia
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Antonio Curnis
- b Division of Cardiology , Spedali Civili Hospital, Università degli Studi di Brescia , Brescia , Italy
| | - Carlo de Asmundis
- a Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing , Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
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O'Brien B, Zafar H, De Freitas S, Sharif F. Transseptal puncture - Review of anatomy, techniques, complications and challenges. Int J Cardiol 2017; 233:12-22. [PMID: 28202256 DOI: 10.1016/j.ijcard.2017.02.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/22/2016] [Accepted: 02/01/2017] [Indexed: 12/17/2022]
Abstract
In recent years, the transseptal puncture approach has enabled passage of increasingly large and complex devices into the left atrium. Traditional tools remain effective in creating and dilating the initial puncture, with an acceptable safety profile. Even for skilled operators, the procedure is technically demanding and requires sound understanding of atrial anatomy. Intracardiac echocardiography is useful in cases of previous septal repair, poorly defined fossa ovalis anatomy or when considering patent foramen ovale portal crossing. Iatrogenic atrial septal defect (iASD) is the most commonly encountered long-term complication and there is increasing evidence that larger devices are leading to symptomatic defects. The size of the sheath crossing the septum is the strongest predictor of iASD formation but other factors such as longer procedure times, significant catheter manipulation and high pulmonary pressures also contribute. Transcatheter mitral valve repair involves the use of large 22 Fr catheters which carry alarmingly high rates of defect persistence with precipitation of symptoms and possible influence on mortality. Long-term follow up data, particularly beyond the 12-month period are lacking and resultantly, evidence to guide management is sparse. Refinements of conventional instruments, as well as innovations to puncture the septum without mechanical pressure, herald a progressively safer future for the transseptal technique.
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Affiliation(s)
- Barry O'Brien
- Biomedical Engineering, School of Engineering & Informatics, National University of Ireland (NUI), Galway, Ireland
| | - Haroon Zafar
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland.
| | - Simon De Freitas
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland
| | - Faisal Sharif
- Cardiovascular Research Centre Galway, School of Medicine, NUI, Galway, Ireland; School of Medicine, NUI, Galway, Ireland; Department of Cardiology, University Hospital Galway, Ireland; BioInnovate, Ireland; CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland
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Erden İ, Erden EÇ, Golcuk E, Aksu T, Yalin K, Güler TE, Özcan KS, Turan B. Impact of transesophageal echocardiography during transseptal puncture on atrial fibrillation ablation. J Arrhythm 2016; 32:170-5. [PMID: 27354860 PMCID: PMC4913159 DOI: 10.1016/j.joa.2015.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/25/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of our study was to demonstrate the added value of routine transesophageal echocardiography (TEE) for correctly positioning the transseptal system in the fossa ovalis (FO), thus potentially preventing complications during fluoroscopy-guided transseptal puncture (TP), and for assessing the optimal puncture site within the FO according to the expected procedure type. METHODS Ninety-one patients undergoing pulmonary vein isolation (PVI) procedures by cryoballoon technique for drug-resistant paroxysmal or persistent atrial fibrillation (AF) were prospectively included. In 57 patients, the TP procedure was performed under fluoroscopic guidance and septal localization was confirmed by contrast injection through the needle and demonstration of septal tenting in both the anteroposterior and left lateral fluoroscopic projections. In 34 patients, TP was performed under TEE guidance and positioning was targeted to perform the TP procedure in the more anterior and inferior locations of the FO. Two patient groups were compared according to the incidence of complications directly attributable to transseptal catheterization, thromboembolic complications, recurrence rates after the ablation procedure, total procedural time, and fluoroscopy time. RESULTS Fluoroscopy time (p<0.001), total cryoablation time (p=0.002), and total procedural time (p<0.001) were shorter in the TEE-guided group. Left inferior pulmonary vein (LIPV) cryoablation time (p=0.007) and right inferior pulmonary vein (RIPV) cryoablation time (p=0.004) were significantly shorter and the number of applications to the LIPV (p=0.007) and RIPV (p=0.005) were significantly fewer in the TEE-guided group. Although there was a trend toward higher complication rates (20.6% vs. 31.6%, p=0.37) and recurrence rates (11.8% vs. 20.1%, p=0.26) in the fluoroscopy-guided group, the differences between the groups were not statistically significant. CONCLUSIONS TEE-guided TP for AF ablation is associated with shorter fluoroscopy time, shorter total cryoablation time, and shorter total procedural time. Importantly, TEE-guided TP facilitates cryoablation of the inferior pulmonary veins.
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Affiliation(s)
- İsmail Erden
- Kocaeli Derince Training and Research Hospital, Department of Cardiology, Ibni Sina Mah., Sopalı Mevki, Lojman Sok., Derince Merkez, PK 41900 Derince, Kocaeli, Turkey
| | - Emine Çakcak Erden
- Kocaeli Derince Training and Research Hospital, Department of Cardiology, Ibni Sina Mah., Sopalı Mevki, Lojman Sok., Derince Merkez, PK 41900 Derince, Kocaeli, Turkey
| | - Ebru Golcuk
- Kocaeli Derince Training and Research Hospital, Department of Cardiology, Ibni Sina Mah., Sopalı Mevki, Lojman Sok., Derince Merkez, PK 41900 Derince, Kocaeli, Turkey
| | - Tolga Aksu
- Kocaeli Derince Training and Research Hospital, Department of Cardiology, Ibni Sina Mah., Sopalı Mevki, Lojman Sok., Derince Merkez, PK 41900 Derince, Kocaeli, Turkey
| | - Kıvanç Yalin
- Bursa State Hospital, Cardiology, Clinic, Hasta Yurdu Cd., No. 31, PK 16040 Tophane, Bursa, Turkey
| | - Tümer Erdem Güler
- Kocaeli Derince Training and Research Hospital, Department of Cardiology, Ibni Sina Mah., Sopalı Mevki, Lojman Sok., Derince Merkez, PK 41900 Derince, Kocaeli, Turkey
| | - Kazım Serhan Özcan
- Kocaeli Derince Training and Research Hospital, Department of Cardiology, Ibni Sina Mah., Sopalı Mevki, Lojman Sok., Derince Merkez, PK 41900 Derince, Kocaeli, Turkey
| | - Burak Turan
- Kocaeli Derince Training and Research Hospital, Department of Cardiology, Ibni Sina Mah., Sopalı Mevki, Lojman Sok., Derince Merkez, PK 41900 Derince, Kocaeli, Turkey
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Kaneko Y, Kato ‘R, Nakahara S, Tobiume T, Morishima I, Tanaka K, Nakajima T, Irie T, Kusano KF, Kamakura S, Nagase T, Takayanagi K, Matsumoto K, Kurabayashi M. Characteristics and Catheter Ablation of Focal Atrial Tachycardia Originating From the Interatrial Septum. Heart Lung Circ 2015; 24:988-95. [DOI: 10.1016/j.hlc.2015.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 02/20/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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Zheng L, Chen Z, Sun M, Zeng H, Zuo D, Hua Y, Cai Z. A preliminary study of the safety and efficacy of radiofrequency ablation with percutaneous kyphoplasty for thoracolumbar vertebral metastatic tumor treatment. Med Sci Monit 2014; 20:556-63. [PMID: 24699431 PMCID: PMC3983101 DOI: 10.12659/msm.889742] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Thoracolumbar vertebral metastasis (TVM) affects a large number of cancer patients. However, safe and effective palliative care remains controversial. The aim of the present study was to investigate the safety and efficacy of minimally invasive image-guided radiofrequency ablation (RFA) with percutaneous kyphoplasty (PKP) for TVM treatment. Material/Methods A retrospective study of 26 patients (mean age: 59.31±11.62 years) was conducted, including 38 vertebral metastases at T11, T12, L1, L2, L3, L4, L5, and S1 with abundant blood vessels. Patients underwent RFA with PKP (4–6 min, 95±5°C, 150 W, effective electrode area of 1.5–2.0 cm) under general anesthesia from February 2005 to January 2009. Electrodes were inserted into the lesions and pre- and post-operative visual analog scale (VAS) scores and X-rays were collected on day 3, week 1, and months 1, 3, and 6. Tumor recurrence and pain level were also evaluated. Safety assessment was conducted based on complications and adverse events. The mean follow-up time was 8.4±2.1 months. Results A mean of 2.69±0.93 ablation was performed per patient. The ablation procedure required a mean of 15.08±4.64 min, while the injection of bone cement required a mean of 6.73±0.83 min, for a mean total operating time of 47.77±7.13 min. Postoperative VAS scores were significantly lower on day 3, week 1, and months 1, 3, and 6 (P<0.01), without any complications or tumor recurrence. Conclusions Image-guided RFA with PKP was safe and effective for TVM treatment when used with careful consideration of bone cement volume/viscosity, injection location, and temperature.
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Affiliation(s)
- Longpo Zheng
- Department of Orthopedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Zhengqi Chen
- Department of Orthopedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Mengxiong Sun
- Department of Orthopedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Hui Zeng
- Department of Orthopedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Dongqing Zuo
- Department of Orthopedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yingqi Hua
- Musculoskeletal Oncology Center, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Zhengdong Cai
- Department of Orthopedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Wang Y, Xue YM, Mohanty P, Natale A, Li L, Wu WF, Zhu CM, Liu H, Zhong GQ, Zhu LG, Zeng ZH, Wang DW. Dilator method and needle method for atrial transseptal puncture: a retrospective study from a cohort of 4443 patients. Europace 2012; 14:1450-1456. [DOI: 10.1093/europace/eus148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Chierchia GB, Namdar M, Sarkozy A, Sorgente A, de Asmundis C, Casado-Arroyo R, Capulzini L, Bayrak F, Rodriguez-Mañero M, Ricciardi D, Rao JY, Overeinder I, Paparella G, Brugada P. Verification of pulmonary vein isolation during single transseptal cryoballoon ablation: a comparison between the classical circular mapping catheter and the inner lumen mapping catheter. Europace 2012; 14:1708-14. [PMID: 22772051 DOI: 10.1093/europace/eus189] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIMS Cryoballoon ablation has proven very effective in achieving pulmonary vein isolation (PVI). The novel Achieve inner lumen mapping catheter designed to be used in conjunction with the cryoballoon, serves as both a guidewire and a mapping catheter. To our knowledge, this is the first study comparing the latter to verification of electrical isolation with the 'traditional' circular mapping catheter. METHODS AND RESULTS We assigned 40 consecutive patients matched for age and left atrial diameter suffering of paroxysmal atrial fibrillation to cryoballoon PVI using either the circular mapping catheter or the Achieve as a mapping catheter. Duration of procedure as well as fluoroscopy times were significantly lower in the Achieve group than in the circular mapping catheter group (111 ± 14 min vs. 126 ± 13 min, P < 0.005 and 22 ± 5 min vs. 29 ± 4 min, P < 0.0001, respectively). There were no significant differences between both groups in terms of mean degree of occlusion, mean minimal temperatures, and PVI. Pulmonary vein isolation could be documented by real-time recordings in 55% of veins in the Achieve group with mean time to isolation of 65 ± 23 s. CONCLUSION Cryoballoon ablation in conjunction with the novel Achieve is feasible, safe, and affords PVI in nearly all veins in similar proportions to the approach with the traditional guidewire. Furthermore, if compared to the procedure with the circular mapping catheter, cryoballoon ablation with the Achieve is significantly faster and associated to shorter fluoroscopy times.
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Affiliation(s)
- Gian-Battista Chierchia
- Heart Rhythm Management Center, Cardiovascular Division, UZ Brussel - Vrije Universiteit Brussel Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
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Bayrak F, Chierchia GB, Namdar M, Yazaki Y, Sarkozy A, de Asmundis C, Muller-Burri SA, Rao J, Ricciardi D, Sorgente A, Brugada P. Added value of transoesophageal echocardiography during transseptal puncture performed by inexperienced operators. Europace 2011; 14:661-5. [PMID: 22117031 DOI: 10.1093/europace/eur366] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS Transseptal puncture (TP) appears to be safe in experienced hands; however, it can be associated with life-threatening complications. The aim of our study was to demonstrate the added value of routine use of transoesophageal echocardiography (TEE) for the correct positioning of the transseptal system in the fossa ovalis, thus potentially preventing complications during fluoroscopy-guided TP performed by inexperienced operators. METHODS AND RESULTS Two hundred and five patients undergoing pulmonary vein isolation procedure (PVI) for drug-resistant paroxysmal or persistent atrial fibrillation were prospectively included. When the operator (initially blinded to TEE) assumed that the transseptal system was in a correct position according to fluoroscopical landmarks, the latter was then checked with TEE unblinding the physician. If necessary, further refinement of the catheter position was performed. Refinement >10 mm, or in case of catheter pointing directly at the aortic root or posterior wall were considered as major repositioning. Thirty-four patients required major repositioning. Regression analysis revealed age (P: 0.0001, Wald: 12.9, 95% confidence interval: 1.04-1.16), left atrial diameter (P: 0.01, Wald: 6.6, 95% confidence interval: 1.04-1.34), previous PVI (P: 0.01, Wald: 6.3, 95% confidence interval: 1.31-8.76), and atrial septal thickness (P: 0.03, Wald: 4.5, 95% confidence interval: 1.05-3.4) as independent predictors of major revision with TEE. CONCLUSION Routine 2D TEE in addition to traditional fluoroscopic TP appears to be very useful to guide the TP assembly in a correct puncture position and thus, to avoid TP-related complications. However, further randomized prospective comparative studies are necessary to support these suggestions.
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Affiliation(s)
- Fatih Bayrak
- Heart Rhythm Management Center, UZ Brussels-VUB, Laarbeeklaan 101, Brussel 1090, Belgium.
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Vahanian A, Himbert D, Brochet E. Transseptal Puncture. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rana BS, Shapiro LM, McCarthy KP, Ho SY. Three-dimensional imaging of the atrial septum and patent foramen ovale anatomy: defining the morphological phenotypes of patent foramen ovale. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 11:i19-25. [PMID: 21078835 DOI: 10.1093/ejechocard/jeq122] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patent foramen ovale (PFO) is known to occur with greater prevalence in those with cryptogenic stroke. These observations support the role of a PFO as a channel for paradoxical embolism and a mechanism for cerebral ischaemic events. Transcatheter closure of PFO may be indicated in this setting. A prerequisite of procedural success is achieving complete closure of the shunt. Studies have shown a varying degree of successful shunt closure. Residual shunts are usually the result of a mismatch between the device shape and PFO anatomy. In this article, we review the features of PFO and their surrounding structures as seen by three-dimensional transoesophageal echocardiography in patients undergoing transcatheter closure and relate these to the variations in morphology on anatomical specimens for a better appreciation of their suitability for closure devices. The salient features of the anatomical variations seen in adults undergoing transcatheter device closure have been summarized and used to produce a practical pre-procedural checklist.
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Affiliation(s)
- Bushra S Rana
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Localization of fossa ovalis and Brockenbrough needle prior to left atrial ablation using three-dimensional mapping with EnSite Fusion™. J Interv Card Electrophysiol 2010; 30:37-44. [DOI: 10.1007/s10840-010-9525-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
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Use of a novel needle wire in patients undergoing transseptal puncture associated with severe septal tenting. J Interv Card Electrophysiol 2010; 27:9-13. [PMID: 20072804 DOI: 10.1007/s10840-009-9460-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION An increasing number of patients undergo left atrial ablation procedures, since several approaches have proven efficacy in the treatment of atrial fibrillation. Although transseptal catheterization was generally shown be a safe technique, it harbors the principal risk of cardiac injury. Therefore, there is a need for a safe and effective tool to enable transseptal puncture in difficult cases as well. METHODS AND RESULTS In 158 consecutive patients, a transseptal puncture was intended for mapping and ablation of left atrial tachycardias. In seven patients of this series transseptal puncture using different sheaths and needle designs, the operators failed to cross the interatrial septum as a result of severe tenting. Three patients were known to have a septal aneurysm; a redo procedure was performed in two patients. In the remaining patients, there was no obvious explanation for the difficulty in crossing the interatrial septum conventionally. In all seven patients, a 120-cm-long nitinol guidewire ("needle wire") with a 0.014-inch diameter was used to cross the atrial septum with the following idea: after tenting the fossa ovalis with the transseptal dilator and the Brockenbrough needle positioned just inside the tip, effortless advancement of the needle wire perforates the membranous fossa. Unsupported by the needle and dilator, the tip of the wire immediately assumes a "J" shape, rendering it incapable of further tissue penetration after its entry into the left atrium. In all seven patients, the needle wire could be placed into a left pulmonary vein. In five patients, a single attempt was sufficient to reach the left atrium with the wire, two patients needed two and three attempts, respectively. No complications occurred. CONCLUSIONS Additional use of a needle wire to perform transseptal puncture in a subset of patients at higher risk for complications appears safe and effective.
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TZEIS STYLIANOS, ANDRIKOPOULOS GEORGE, DEISENHOFER ISABEL, HO SIEWYEN, THEODORAKIS GEORGE. Transseptal Catheterization: Considerations and Caveats. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:231-42. [DOI: 10.1111/j.1540-8159.2009.02598.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Silvestry FE, Kerber RE, Brook MM, Carroll JD, Eberman KM, Goldstein SA, Herrmann HC, Homma S, Mehran R, Packer DL, Parisi AF, Pulerwitz T, Seward JB, Tsang TSM, Wood MA. Echocardiography-guided interventions. J Am Soc Echocardiogr 2009; 22:213-31; quiz 316-7. [PMID: 19258174 DOI: 10.1016/j.echo.2008.12.013] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A major advantage of echocardiography over other advanced imaging modalities (magnetic resonance imaging, computed tomographic angiography) is that echocardiography is mobile and real time. Echocardiograms can be recorded at the bedside, in the cardiac catheterization laboratory, in the cardiovascular intensive care unit, in the emergency room-indeed, any place that can accommodate a wheeled cart. This tremendous advantage allows for the performance of imaging immediately before, during, and after various procedures involving interventions. The purpose of this report is to review the use of echocardiography to guide interventions. We provide information on the selection of patients for interventions, monitoring during the performance of interventions, and assessing the effects of interventions after their completion. In this document, we address the use of echocardiography in commonly performed procedures: transatrial septal catheterization, pericardiocentesis, myocardial biopsy, percutaneous transvenous balloon valvuloplasty, catheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO), alcohol septal ablation for hypertrophic cardiomyopathy, and cardiac electrophysiology. A concluding section addresses interventions that are presently investigational but are likely to enter the realm of practice in the very near future: complex mitral valve repairs, left atrial appendage (LAA) occlusion devices, 3-dimensional (3D) echocardiographic guidance, and percutaneous aortic valve replacement. The use of echocardiography to select and guide cardiac resynchronization therapy has recently been addressed in a separate document published by the American Society of Echocardiography and is not further discussed in this document. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures.
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Affiliation(s)
- Frank E Silvestry
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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