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Usefulness of intracardiac echocardiography in complex transseptal catheterization during percutaneous transvenous
1Section of Cardiology, Chang Gung Medical College, Taiwan, Republic of China.
Insights
Intracardiac echocardiography safely guides complex transseptal catheterization in high-risk patients. This imaging technique enhances procedural success for conditions like mitral stenosis and giant left atria.
Area of Science:
- Cardiovascular Interventions
- Medical Imaging
- Cardiac Surgery
Background:
- Transseptal catheterization is crucial for procedures like percutaneous transvenous mitral commissurotomy.
- Complex cases, including those with giant left atria or anatomical variations, pose significant technical challenges.
- Traditional methods may have limitations in visualizing critical structures during these procedures.
Purpose of the Study:
- To evaluate the effectiveness of intracardiac echocardiography (ICE) in guiding complex transseptal catheterization.
- To assess the utility of ICE in high-risk patients undergoing percutaneous transvenous mitral commissurotomy.
- To determine if ICE can improve safety and efficiency in challenging transseptal punctures.
Main Methods:
- A cohort of 15 patients with mitral stenosis and complex anatomical features were studied.
- An 8-F 10-MHz intracardiac transducer catheter was utilized for real-time imaging.
- Echocardiographic visualization confirmed the Brockenbrough needle tip position prior to septal puncture.
Main Results:
- Transseptal puncture was successfully and uncomplicatedly achieved in all 15 patients.
- Intracardiac echocardiography obviated the need for atrial angiography.
- Accurate needle tip localization was confirmed, and inadvertent puncture of atrial septal aneurysms was avoided.
Conclusions:
- Intracardiac echocardiography is a valuable tool for facilitating complex transseptal catheterization.
- The technique enhances safety and efficacy in patients with challenging anatomy, including giant left atria and atrial septal aneurysms.
- ICE offers a reliable alternative to traditional imaging modalities for guiding transseptal interventions.
Objective:
To examine the utility of intracardiac echocardiography in guiding complex transseptal catheterization of patients undergoing percutaneous transvenous mitral commissurotomy.
Design:
We assessed this procedure in high-risk patients in whom transseptal catheterization is technically complex and more demanding.
Material And Methods:
Fifteen patients with mitral stenosis were studied. Twelve patients had giant left atria (70 mm or more), two had atrial septal aneurysms, and one had severe kyphoscoliosis. A newly developed 8-F 10-MHz intracardiac transducer catheter was placed in the right atrium through an 8-F Mullins sheath inserted from the left femoral vein. Echocardiographic images were used to confirm the septal position of the Brockenbrough needle tip before septal punctures.
Results:
Transseptal puncture was successful and uncomplicated in all 15 patients. Use of intracardiac echocardiography eliminated the need for atrial angiography. Before transseptal puncture, the needle tip was identified to be in contact with the atrial septum, as an echogenic point with its acoustic shadow and septal indentation. In addition, in the two patients with aneurysms, puncture of the thin-walled aneurysms was avoided.
Conclusion:
Intracardiac echocardiography facilitates safe complex transseptal catheterization in patients with mitral stenosis and giant left atria, atrial septal aneurysms, or severe kyphoscoliosis.