title: Full-color direct visualization of the atrial septum to guide transseptal puncture.
abstract: BACKGROUND
  Transseptal puncture is required for many interventional procedures but has a serious complication rate of approximately 1%-primarily related to misidentification of the fossa ovalis resulting in inadvertent puncture of other cardiac structures. We investigated the utility of a full color visualization catheter to correctly position and guide transseptal puncture of the fossa ovalis.
  
  
  RESULTS
  Transseptal puncture and left atrial cannulation were performed after visualization of the atrial septum and fossa ovalis with the visualization catheter (IRIS, Voyage Medical Inc.) on six swine. For each animal, the transseptal puncture was performed twice and the catheter was examined for clot after each puncture. The 12 transseptal punctures required 6.8 +/- 3.6 minutes procedural time and 300 +/- 94 mL of fluid administered per procedure (i.e., two punctures). IRIS visualization of the atrial septum correlated well with postmortem examination of the atrial septum. In the three animals in which a patent foramen ovale was present (as confirmed by pathological examination), it was also correctly identified by in vivo visualization using the IRIS catheter.
  
  
  CONCLUSIONS
  The IRIS catheter allows direct in vivo visualization of the interatrial septum to guide transseptal puncture of previous punctures.
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Thiagalingam
authors.forename: Andre
authors.initials: A
authors.lastname: D'Avila
authors.forename: Lori
authors.initials: L
authors.lastname: Foley
authors.forename: Melodie
authors.initials: M
authors.lastname: Fox
authors.forename: Chris
authors.initials: C
authors.lastname: Rothe
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.forename: Zach
authors.initials: Z
authors.lastname: Malchano
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
mesh_terms: D000818:Animals; D054087:Atrial Septum / Q000033:anatomy & histology* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D003116:Color; D019723:Endoscopes; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D011677:Punctures / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine; D014741:Video Recording / Q000295:instrumentation