title: Transseptal left heart catheterisation guided by intracardiac echocardiography.
abstract: OBJECTIVE
  To develop a novel approach of transseptal puncture guided by intracardiac echocardiography and to assess its efficacy.
  
  
  METHODS
  Transcatheter intracardiac echocardiography with a 9 MHz rotating transducer was performed to guide transseptal puncture in 12 patients (mean age 43.1 years, range 31-68) who underwent radiofrequency catheter ablation of left sided accessory pathways. Initially, the echocardiography and transseptal catheters were placed adjacent to each other in the superior vena cava and were withdrawn to the level of the fossa ovalis.
  
  
  RESULTS
  The successful puncture site was associated with visualisation of the fossa ovalis (12 patients, 100%) and the aorta (12 patients, 100%), tenting of the fossa (six patients, 50%), penetration of the needle visualised by the ultrasound catheter (12 patients, 100 %), and echocardiographic contrast material applied in the left atrium (12 patients, 100%). The characteristic jump of the needle onto the fossa ovalis was observed simultaneously with fluoroscopy and intracardiac ultrasound (12 patients, 100%). All procedures were successful. There were no complications associated with the transseptal procedure.
  
  
  CONCLUSIONS
  Intracardiac echocardiography is feasible to guide transseptal puncture. The optimal puncture site can be assessed by simultaneous detection of the characteristic downward jump of the transseptal needle onto the fossa ovalis by intracardiac ultrasound and fluoroscopy.
authors.affiliation: Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. szili@card.azr.nl
authors.forename: T
authors.initials: T
authors.lastname: Szili-Torok
authors.forename: G
authors.initials: G
authors.lastname: Kimman
authors.forename: D
authors.initials: D
authors.lastname: Theuns
authors.forename: J
authors.initials: J
authors.lastname: Res
authors.forename: J R
authors.initials: JR
authors.lastname: Roelandt
authors.forename: L J
authors.initials: LJ
authors.lastname: Jordaens
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods*; D018084:Ultrasonography, Interventional