Full-color direct visualization of the atrial septum to guide transseptal puncture.
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.
Thiagalingam
Aravinda
A
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
D'Avila
Andre
A
Foley
Lori
L
Fox
Melodie
M
Rothe
Chris
C
Miller
David
D
Malchano
Zach
Z
Ruskin
Jeremy N
JN
Reddy
Vivek Y
VY
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