A New Approach for Transseptal Catheterization in Patients Undergoing Percutaneous Balloon Mitral Valvuloplasty

Abstract

Aims: To evaluate the safety and efficacy of a new approach for transseptal catheterization in patients undergoing percutaneous balloon mitral valvuloplasty (PBMV). Methods: One hundred and two patients with rheumatic mitral stenosis were randomized into two groups. In the study group (RA approach), an imaginary horizontal line was drawn from the top end of the tricuspid valve under anteroposterior fluoroscopic view. The intersection of the horizontal line and the right edge of the corresponding thoracic vertebra was defined as the upper border of the Fossa ovalis. The atrial septum was punctured from a point 0.5 cm below the upper border of the Fossa ovalis. In the control group (LA approach), an imaginary horizontal line was drawn between the upper and middle third of the left atrium, and the intersection of this horizontal line and the right edge of the corresponding thoracic vertebra was used as an atrial septum puncture point. Results: Atrial septum puncture succeeded in all patients in the study group and in 72.6% of the patients in the control group (p < 0.01). The average fluoroscopy times for transseptal catheterization in the study and the control groups were 2.0 ± 0.5 and 3.0 ± 1.0 min, respectively (p < 0.01). Transseptal catheterization was subsequently achieved using the RA approach in the 14 patients from the control group in whom the LA approach failed. Conclusions: The RA approach is a safe and effective means for transseptal catheterization in patients undergoing PBMV.

Value of Radiographic Esophageal Imaging in Determining an Optimal Atrial Septal Puncture Site for Percutaneous Balloon Mitral Valvuloplasty

“…The Ross method, or a modified version of it, has been widely used for this procedure. However, the Ross method largely depends on the quality of fluoroscopic displays of the left atrial silhouette, which is not always clearly seen in patients with mitral valve disease [7,8] .…”

“…After informed consent was obtained, 468 patients (203 males, aged 38-72 years, mean 56 8 16 years) were recruited between January 2002 and June 2006. Patients were randomized into either a study group (n = 234), in which radiographic esophageal imaging was used to aid the transseptal puncture, or the control group (n = 234), in which transseptal punctures were performed with the Ross technique [6][7][8] .…”

“…In the control group, a conventional transseptal puncture technique was used [6][7][8] . Under anterior-posterior fluoroscopic view, the left atrium was visually divided into 3 equal parts from the upper to the lower end.…”

“…Under anterior-posterior fluoroscopic view, the left atrium was visually divided into 3 equal parts from the upper to the lower end. An imaginary horizontal line was drawn between the middle and the lower third of the left atrial silhouette; the intersection of the horizontal line and the point between the middle and the right third of the corresponding thoracic vertebra was defined as the site of the atrial septum puncture [7,8] . If the diameter of left atrium was 1 45 mm, an imaginary horizontal line was drawn between the middle and the lower quarter of the impression; the intersection of the horizontal line and the point between the middle and the right quarter of the corresponding thoracic vertebra was defined as the site of the atrial septum puncture.…”

“…Since then, the transseptal puncture technique for diagnostic left heart catheterization or PBMV has been extensively described [7][8][9][10][11][12][13][14] . The purpose of this study was to assess the value of using the left atrial impression on the esophagus as a landmark for the atrial septum puncture site.…”