title: Comparisons of mechanical versus phase-array intracardiac echocardiography-assisted transseptal puncture in patients with dilated left atrium undergoing percutaneous transvenous mitral commissurotomy.
abstract: 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.
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, #160 Section 3 Taichung Kang Road, Taichung, Taiwan.
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: Kuo-Yang
authors.initials: KY
authors.lastname: Wang
authors.forename: Chih-Tai
authors.initials: CT
authors.lastname: Ting
authors.forename: Sheng-Ling
authors.initials: SL
authors.lastname: Jan
authors.forename: Wei-Wen
authors.initials: WW
authors.lastname: Lin
authors.forename: I-Hsiang
authors.initials: IH
authors.lastname: Lin
mesh_terms: 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*