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

Abstract

Objective: To investigate the value of radiographic esophageal imaging in facilitating transseptal catheterization in patients undergoing percutaneous balloon mitral valvuloplasty. Subjects and Methods: A total of 468 patients were randomized into either the study group (n = 234), in which radiographic esophageal imaging by the oral administration of a contrast media took place, or the control group (n = 234), in which the Ross technique was used.Of the 468 patients, 203 were males and 265 were females. The average ages of the study and control groups were 53 ± 16 and 51 ± 17 years, respectively. The patients had severe left atrial enlargement, as measured using 2-dimensional echocardiography. Results: In the study group, the left atrial impression on the esophagus was clearly seen, and was used to identify the puncture site on the right atrial side for the passage of the transseptal catheter. In the control group, the left atrial silhouette was not clearly shown by fluoroscopy in 112 patients (47.5%). The success rate of transseptal catheterization in the study group was higher than in the control group (99.6 vs. 45.7%, p = 0.0001). There were no complications in the study group, but pericardial tamponade occurred in 1 patient in the control group. Conclusion: Radiographic esophageal imaging facilitates the identification of an optimal atrial transseptal puncture site, and improves the success rate of transseptal catheterization in patients undergoing percutaneous balloon mitral valvuloplasty.

Novel Solutions Applied in Transseptal Puncture: A Systematic Review

“…A low complication rate and no failure were reported, proving therefore the safety and feasibility of the new method in clinical practice. Furthermore, lower procedural time was reported [35,38]. Faletra et al presented extended reports about atrial anatomy interpretation in 3D TEE [33,36].…”

“…In order to overcome the limitations of the procedures only guided by fluoroscopy, several authors exploited the application of new imaging modalities in TSP (Table 5), namely: transesophageal echocardiography (TEE) [19,[33][34][35][36][37][38], intracardiac echocardiography (ICE) [9,[39][40][41][42][43], real-time magnetic resonance (MR) [44] and direct color visualization [45]. Furthermore, needle tracking based on electromagnetic sensors [46] and electroanatomic mapping (EAM) [17,[47][48][49][50][51][52] were also presented.…”

“…Wu et al and Chierchia et al suggested the application of 2D [38] and 3D [35] TEE, respectively, in TSP to correct the alignment between the needle and FO. The authors validated this novel image guidance approach in humans.…”