Anterior staircase manoeuvre for atrial transseptal puncture.

Abstract

After a Brockenbrough or Mullins transseptal catheter had been advanced into the lower half of the right atrium through a J shaped guidewire, the guidewire was removed and the curved tip Brockenbrough needle was advanced so that its tip lay just within the catheter. The needle was rotated so that the direction arrow at its hub faced 12 o'clock as viewed from below (fig 1). With the needle and catheter constantly moved from side to side between the 10 and 2 o'clock positions, the catheter and needle were advanced to the top of the right atrium and then rotated posteromedially (fig 1). The continual side to side movement as the catheter and needle advanced to the top of the right atrium immediately detected any tendency to snag on the atrial wall. Snagging rarely occurred because when the inferior vena cava enters at the posterior aspect of right atrium there is an anterior space in which this anterior staircase movement can take place (fig 2)

Transseptal puncture by CTP-2 method

“…[2,3,9,11,16,17] Traditionally, left atriography was used for determine the optimal puncture site. It is a relatively safe method.…”

“…Fluoroscopy is the basic and essential modality for guiding TSP in many medical centers at present and likely will be used in a considerable period. [ 2 , 3 , 9 , 11 , 16 , 17 ] Traditionally, left atriography was used for determine the optimal puncture site. It is a relatively safe method.…”

“…Various imaging modalities such as intracardiac echocardiography have been reported and may be helpful for locating the puncture site, but the needs of specific instruments limit their uses. [ 7 – 9 ] On the other hand, TSP guided by fluoroscopy is more convenient, and likely will be the mainstay in a considerable long period in many medical centers, especially in the developing countries. Therefore, there is much interest in improving the technique of transseptal access guided by fluoroscopy.…”