Emerging Applications for Transseptal Left Heart CatheterizationOld Techniques for New Procedures
Vasilis C. Babaliaros, MD*,
Jacob T. Green, MD,
Stamatios Lerakis, MD, FACC,
Michael Lloyd, MD and
Peter C. Block, MD, FACC
Andreas Gruentzig Cardiovascular Center, Emory University Hospital, Atlanta, Georgia.
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Figure 1 Gross Examination of the FO From the Right Atrium
Right atrial view of the atrial septum with limbic ledge seen superiorly (below dotted line) and depressed fossa ovalis (FO) inferiorly. SVC = superior vena cava.
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Figure 2 Fluoroscopic Views During Transseptal Puncture
(A) Transseptal puncture performed in the anteroposterior projection with fluoroscopic imaging. The pigtail catheter marks the location of the aortic valve, and the tip of the transseptal dilator engages the fossa ovalis inferiorly and medially to the aortic valve. (B) Transseptal puncture performed in the lateral fluoroscopic projection. The transseptal dilator engages the fossa ovalis in the lower third of the imaginary line (thin dashed line) connecting the pigtail catheter (aortic valve) and the posterior wall of the left atrium (heavy dashed line). (C) Transseptal puncture performed in the right anterior oblique projection with fluoroscopic imaging. The transseptal dilator (TC) engages the fossa ovalis posterior to the pigtail catheter (aortic valve) but anterior to right atrial silhouette (dashed line).
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Figure 3 2- and 3-Dimensional Echocardiographic Views During Transseptal Puncture
(A) 2-dimensional transesophageal echocardiographic imaging depicts tenting (arrow) of the atrial septum into the left atrium (LA). (B) 3-dimensional transesophageal echocardiographic imaging visualizes tenting (arrow) of the atrial septum. RA = right atrium.
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Figure 4 Pressure Tracing From Transseptal Needle During Transseptal Catheterization
Right atrial (RA) pressure wave form becomes blunted (BP) as the needle engages the septum. After the needle passes through the septum, a left atrial (LA) pressure wave form is seen.
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Figure 5 New Transseptal Catheterization Techniques Using a Radiofrequency Catheter or an Internal Jugular Vein Approach
(A) A radiofrequency catheter is inserted into dilator and sheath and ablates a thickened atrial septum to cross into the left atrium (courtesy of Radiofrequency Transseptal System, Baylis Medical, Montreal, Quebec, Canada). (B) The LA-Crosse system uses a stabilizer sheath, a guide catheter, and a flexible puncture screw to safely cross the atrial septum from the right internal jugular vein (courtesy of St. Jude Medical, St. Paul, Minnesota).
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