Use of two-dimensional echocardiography during transseptal cardiac catheterization

Inadvertent puncture of the intrapericardial aorta is a serious complication of transseptal catheterization. Two-dimensional echocardiography allows delineation and spatial resolution of the aorta and interatrial septum. Thirteen patients underwent transseptal catheterization with simultaneous monitoring of needle and catheter position using fluoroscopy and two-dimensional echocardiography. The interatrial septum was demonstrated in the short-axis and four chamber views, and clearly separated from the ascending aorta. The transseptal needle and catheter were visualized by echocardiography while the needle tip was manipulated into the fossa ovalis avoiding puncture of the aortic root. In some cases, under pressure from the needle tip just before puncture, the interatrial septum appears to bulge toward the left atrium. Saline solution contrast echocardiography helped to confirm the needle position in the right atrium, and in the left atrium after puncture. These data suggest that two-dimensional echocardiography is a useful adjunct to fluoroscopy during transseptal catheterization that may improve its safety and prevent complications.