Full-Color Direct Visualization of the Atrial Septum to Guide Transseptal Puncture

Introduction: Transseptal puncture is required for many interventional procedures but has a serious complication rate of ∼1%—primarily related to misidentification of the fossa ovalis resulting in inadvertent puncture of other cardiac structures. We investigated the utility of a full color visualiza...

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Bibliographic Details
Published in:Journal of cardiovascular electrophysiology 2008-12, Vol.19 (12), p.1310-1315
Main Authors: THIAGALINGAM, ARAVINDA, D'AVILA, ANDRE, FOLEY, LORI, FOX, MELODIE, ROTHE, CHRIS, MILLER, DAVID, MALCHANO, ZACH, RUSKIN, JEREMY N., REDDY, VIVEK Y.
Format: Article
Language:English
Subjects:
Animals
atrial fibrillation
Atrial Septum - anatomy & histology
Atrial Septum - surgery
atrium
Cardiac Catheterization - instrumentation
catheter ablation
Color
electrophysiology
Endoscopes
Equipment Design
Equipment Failure Analysis
Female
Punctures - instrumentation
Punctures - methods
Surgery, Computer-Assisted - methods
Swine
valvuloplasty
Video Recording - instrumentation
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Summary:Introduction: Transseptal puncture is required for many interventional procedures but has a serious complication rate of ∼1%—primarily related to misidentification of the fossa ovalis resulting in inadvertent puncture of other cardiac structures. We investigated the utility of a full color visualization catheter to correctly position and guide transseptal puncture of the fossa ovalis. Methods and Results: Transseptal puncture and left atrial cannulation were performed after visualization of the atrial septum and fossa ovalis with the visualization catheter (IRIS, Voyage Medical Inc.) on six swine. For each animal, the transseptal puncture was performed twice and the catheter was examined for clot after each puncture. The 12 transseptal punctures required 6.8 ± 3.6 minutes procedural time and 300 ± 94 mL of fluid administered per procedure (i.e., two punctures). IRIS visualization of the atrial septum correlated well with postmortem examination of the atrial septum. In the three animals in which a patent foramen ovale was present (as confirmed by pathological examination), it was also correctly identified by in vivo visualization using the IRIS catheter. Conclusion: The IRIS catheter allows direct in vivo visualization of the interatrial septum to guide transseptal puncture of previous punctures.
ISSN:1045-3873
1540-8167
DOI:10.1111/j.1540-8167.2008.01304.x