Comparisons of mechanical versus phase-array intracardiac echocardiography-assisted transseptal puncture in patients with dilated left atrium undergoing percutaneous transvenous mitral commissurotomy.
BACKGROUND
Percutaneous transvenous mitral commissurotomy (PTMC) is an effective treatment for mitral stenosis, but transseptal puncture carries a certain risk of complications. Our previous report has shown the effectiveness of phase-array intracardiac echocardiography (ICE)-guided transseptal puncture in patients with dilated left atrium undergoing PTMC. However, there are few reports comparing the new-generation mechanical versus phase-array ICE-guided transseptal puncture in PTMC.


METHODS
Between March 2007 and March 2008, 6 consecutive patients with symptomatic mitral stenosis with dilated left atrium (range, 4.1-6.1 cm) underwent transseptal puncture by mechanical ICE guidance in PTMC by the same experienced operator. The procedural, echocardiographic and clinical results were retrospectively retrieved and analyzed. In addition, phase-array ICE-guided transseptal cases (n = 7), which included consecutive cases from May to December 2008, were compared.


RESULTS
All 6 patients could have fossa ovalis visualized by ICE, and none of them had false transseptal puncture. Mechanical ICE provided a panoramic wider view of the interatrium septum, and offered better knowledge of the needle's geographic contact to the fossa ovalis than did the phase-array system. The fluoroscopic time of PTMC in the mechanical ICE-guided group (37 ± 9 minutes, n = 6) was similar (p = 0.465) to that of phase-array guidance (31 ± 15 minutes, n = 7).


CONCLUSIONS
Mechanical ICE is effective in guiding transseptal puncture in PTMC.
Liang
Kae-Woei
KW
Cardiovascular Center, Taichung Veterans General Hospital, #160 Section 3 Taichung Kang Road, Taichung, Taiwan.
Fu
Yun-Ching
YC
Lee
Wen-Lieng
WL
Wang
Kuo-Yang
KY
Ting
Chih-Tai
CT
Jan
Sheng-Ling
SL
Lin
Wei-Wen
WW
Lin
I-Hsiang
IH
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D004108:Dilatation, Pathologic; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011677:Punctures / Q000379:methods*