title: Aortic intracardiac echocardiography-guided septal puncture during mitral valvuloplasty.
abstract: OBJECTIVE
  Transoesophageal echocardiography (TEE) and venous intracardiac echocardiography (ICE) are traditionally used to visualize the interatrial septum (IAS) and the tenting effect of the fossa ovalis in patients undergoing percutaneous balloon mitral valvuloplasty (PBMV). The aim of the present study was to assess the comparative efficacy and safety of arterial (intra-aortic) ICE and venous ICE, compared with TEE (traditional approach), in the patients undergoing PBMV.
  
  
  RESULTS
  TEE, aortic ICE, and venous ICE were consecutively performed in 50 patients (40 ± 9 years, 86% female). The images of intracardiac structures were obtained from both aortic and right atrial loci. The IAS was visualized using TEE, aortic ICE, and venous ICE. The mean mitral valve area was 1.14 ± 0.2 cm(2), and the mean left atrial volume index was 57.5 ± 12 mL/m(2). The mean size of the visualized septal length was 48 ± 5 mm by TEE, 51 ± 5 mm by aortic ICE, and 33 ± 6 mm by venous ICE. The Bland-Altman test indicated that the 95% limits of agreement for the measurement of septal diameter ranged from -11.0 to +5.9 mm (mean -2.5 mm) between TEE and aortic ICE, -2.8 to +33.5 mm (mean +15.3 mm) between TEE and venous ICE, and -36.6 to +0.8 mm (mean -17.9 mm) between venous and aortic ICE. Standard venous ICE generally tended to yield smaller values compared with TEE and aortic ICE for the measurement of septal length. Furthermore, the view of fossa ovalis and 'tenting effect' was optimal in 11 patients on venous ICE; however, the fossa ovalis and tip of the needle were well visualized in all patients on aortic ICE (P < 0.001). There were no major complications with the use of aortic ICE.
  
  
  CONCLUSIONS
  Aortic ICE is a superior alternative to venous ICE and facilitates trans-septal puncture in patients with mitral stenosis.
authors.affiliation: Department of Cardiology, Gaziantep State Hospital, Hurriyet Caddesi No. 23, Sahinbey, Gaziantep, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Akkaya
authors.forename: Ertan
authors.initials: E
authors.lastname: Vuruskan
authors.forename: Ali
authors.initials: A
authors.lastname: Zorlu
authors.forename: Isa
authors.initials: I
authors.lastname: Sincer
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kucukosmanoglu
authors.forename: Idris
authors.initials: I
authors.lastname: Ardic
authors.forename: Mehmet Birhan
authors.initials: MB
authors.lastname: Yilmaz
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D011677:Punctures; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Aortic intracardiac echocardiography; Mitral valvuloplasty; Transesophageal echocardiography; Venous intracardiac echocardiography