title: Intra-cardiac echocardiography guided trans-septal puncture in patients with dilated left atrium undergoing percutaneous transvenous mitral commissurotomy.
abstract: Percutaneous transvenous mitral commissurotomy (PTMC) is an effective treatment for mitral stenosis, but trans-septal puncture carries a certain risk of complications. There have been few reports on phase-array intra-cardiac echocardiography (ICE) guidance in trans-septal puncture for PTMC, especially in patients with dilated left atrium or distorted anatomy. Herein, we report our preliminary experience with ICE-guided trans-septal puncture in patients with dilated left atrium (>or=5.5 cm) who underwent PTMC. From June 2005 to March 2006, there were nine consecutive patients with symptomatic mitral stenosis and left atrium size larger than 5.5 cm who underwent trans-septal puncture for PTMC with the ICE guidance in this institution by a same operator. The procedural and catheterization results were analyzed. Using ICE guidance, the success rate for trans-septal puncture was 100% for all patients with dilated left atrium (>or=5.5 cm). The trans-septal procedures were free of major and minor complications and the patients were not exposed to contrast medium. Mitral valve area increased significantly from 1.0+/-0.2 cm(2) to 1.9+/-0.2 cm(2). Our preliminary result showed that ICE safely and effectively guided trans-septal puncture for PTMC in patients with dilated left atrium (>or=5.5 cm), thus eliminating contrast medium usage and avoiding unnecessary longer X-ray exposure.
authors.forename: Kae-Woei
authors.initials: KW
authors.lastname: Liang
authors.forename: Yun-Ching
authors.initials: YC
authors.lastname: Fu
authors.forename: Wen-Lieng
authors.initials: WL
authors.lastname: Lee
authors.forename: Tsun-Jui
authors.initials: TJ
authors.lastname: Liu
authors.forename: Kuo-Yang
authors.initials: KY
authors.lastname: Wang
authors.forename: Chung-Whei
authors.initials: CW
authors.lastname: Hsueh
authors.forename: I-Hsiang
authors.initials: IH
authors.lastname: Lin
authors.forename: Ying-Tsung
authors.initials: YT
authors.lastname: Chen
authors.forename: Chih-Tai
authors.initials: CT
authors.lastname: Ting
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D004108:Dilatation, Pathologic; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011677:Punctures / Q000379:methods; D014463:Ultrasonography