title: Usefulness of intracardiac echocardiography in complex transseptal catheterization during percutaneous transvenous mitral commissurotomy.
abstract: OBJECTIVE
  To examine the utility of intracardiac echocardiography in guiding complex transseptal catheterization of patients undergoing percutaneous transvenous mitral commissurotomy.
  
  
  METHODS
  We assessed this procedure in high-risk patients in whom transseptal catheterization is technically complex and more demanding.
  
  
  METHODS
  Fifteen patients with mitral stenosis were studied. Twelve patients had giant left atria (70 mm or more), two had atrial septal aneurysms, and one had severe kyphoscoliosis. A newly developed 8-F 10-MHz intracardiac transducer catheter was placed in the right atrium through an 8-F Mullins sheath inserted from the left femoral vein. Echocardiographic images were used to confirm the septal position of the Brockenbrough needle tip before septal punctures.
  
  
  RESULTS
  Transseptal puncture was successful and uncomplicated in all 15 patients. Use of intracardiac echocardiography eliminated the need for atrial angiography. Before transseptal puncture, the needle tip was identified to be in contact with the atrial septum, as an echogenic point with its acoustic shadow and septal indentation. In addition, in the two patients with aneurysms, puncture of the thin-walled aneurysms was avoided.
  
  
  CONCLUSIONS
  Intracardiac echocardiography facilitates safe complex transseptal catheterization in patients with mitral stenosis and giant left atria, atrial septal aneurysms, or severe kyphoscoliosis.
authors.affiliation: Section of Cardiology, Chang Gung Medical College, Taiwan, Republic of China.
authors.forename: J S
authors.initials: JS
authors.lastname: Hung
authors.forename: M
authors.initials: M
authors.lastname: Fu
authors.forename: K H
authors.initials: KH
authors.lastname: Yeh
authors.forename: C J
authors.initials: CJ
authors.lastname: Wu
authors.forename: P
authors.initials: P
authors.lastname: Wong
mesh_terms: D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006322:Heart Aneurysm / Q000150:complications; D006325:Heart Atria; D006801:Humans; D007738:Kyphosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery; D012600:Scoliosis / Q000150:complications