Transseptal puncture by CTP-2 method

Abstract

The current used parameters for transseptal puncture (TSP) under fluoroscopic guidance is from left atriography and need to be verified by precise anatomic measurement. From February 2009 to July 2013, consecutive patients who received computed tomography (CT) were included. Landmarks and parameters were preliminary studied by right atriography, and further evaluated on the CT images of 1001 patients. A method (CTP-2) was proposed for guiding TSP. In right anterior oblique 45° view, the CTP-2 method was defined by points C, T, and P, and 2 areas: point C is in coronary sinus; point T is at a distance of dCT (usually 1.5 ± 0.2 vertebral height) over point C; then point P, the optimal puncture site, was located at 0.5 ± 0.2 vertebral body height posterior to point T; puncture should avoid the aortic root area and the rear triangle area; the aortic root area could be negatively revealed by right atriography at the orifice of inferior vena cava, and the rear triangle area is demarcated by points C, C′, and T′ (C′ and T′ are 2 points horizontally posterior to, and at dCT away from points C and T, respectively). The initial application of CTP-2 in 2820 patients showed that it might be helpful in reducing the need of left atriography and the possibility of cardiac perforation.

The efficiency and safety of multidetector computed tomography‐guided transseptal puncture during atrial fibrillation catheter ablation

“…TSP could result in life‐threatening complications and was traditionally conducted at 40° in RAO projection. Previous study showed that the best angle for projecting the septum was RAO 36° 6 . However, according to the present study, the orientation of the IAS varies widely, ranging from 16° to 53°, which poses challenges to the traditional practice of TSP with fixed RAO X‐ray projection.…”

“…In this study, we reported a novel and easy way to adjust the projection of X‐ray during TSP procedural according to the IAS orientation measured from the MDCT scan. There was also other MDCT‐guided method reported previously 6 . However, with only one plane to determine the angulation, our method is more straightforward.…”

Coronary sinus as an anatomical landmark for atrial transseptal puncture

“…Как уже указывалось выше, для определения направления иглы для пункции МПП может быть использован такой ориентир, как катетер в КС. Однако, необходимо подчеркнуть, что в доступной литературе лишь немногими была изучена взаимосвязь между МПП и КС [11,12]. В нашей работе было впервые изучено взаимоотношение этих анатомических структур у пациентов, которым в последующем выполнялась КБИ УЛВ.…”

“…В то же время метод, предложенный Y. Wang et al (2016) [12] для определения оптимального места пункции МПП под рентгеноскопическим контролем, использует как точку отсчёта место бифуркации средней вены сердца в КС. Согласно авторам, наиболее подходящая точка для пункции находилась в середине МПП, в её наиболее широкой части.…”

“…В свою очередь, Y. Wang et al (2016) разработали и предложили метод определения места пункции МПП, основываясь на анализе мультспиральной компьютерной томографии (МСКТ) пациентов и данных рентгеноскопии [12]. Кроме того, в доступной нам литературе мы не встретили работ, которые изучали бы взаимоотношение этих анатомических структур у пациентов, которым выполнялась криобаллонная изоляция (КБИ) устьев лёгочных вен (УЛВ).…”