The Experts below are selected from a list of 51 Experts worldwide ranked by ideXlab platform
C. R. Conti - One of the best experts on this subject based on the ideXlab platform.
-
Editor's Note: Transseptal Left Heart Catheterization for Radiofrequency Ablation of Accessory Pathways
Clinical cardiology, 1993Co-Authors: C. R. ContiAbstract:In summary, I think it is important to state that Transseptal left heart Catheterization is a safe procedure when the operator pays meticulous attention to detail. Potential complications can be avoided if the operator: (1) heparinizes the sheath prior to Catheterization, (2) fully heparinizes the patient when the Catheter and sheath are across the septum, and (3) remembers that the left atrium in these patients is quite small and can be perforated easily by the tapered tip of the Transseptal Catheter. Transesophageal cardiac ultrasound makes this latter point very clear to anyone doing this procedure.
Yu-chang Chen - One of the best experts on this subject based on the ideXlab platform.
-
Usefulness of intracardiac echocardiography in Transseptal puncture during percutaneous transvenous mitral commissurotomy.
The American journal of cardiology, 1993Co-Authors: Jui-sung Hung, Kou-ho Yeh, Sarah Chua, Yu-chang ChenAbstract:P ercutaneous transvenous mitral commissurotomy has become an effective and safe alternative to surgical treatment in well-selected patients.’ Transseptal Catheterization is a vital component of the procedure. Because of its technical complexity and difEculty, Transseptal Catheterization is recommended to be restricted to highvolume Catheterization laboratories equipped with biplane fluoroscopy.2 Recently, usefulness of transthoracic 2dimensional echocardiography and transesophageal echocardiography‘t in guiding Transseptal puncture has been reported. However, transthoracic 2-dimensional echocardiography may be limited by suboptimal interatria1 septum visualization. In addition, placement of the transducer on the patient’s chest not only interferes with the fluoroscopic images, but also poses a radiation hazard to the echocardiographer. Space limitations in the Catheterization laboratory and a need to preserve a sterile field also make this examination cumbersome. Transesophageal echocardiography allows high-quality visualization of the interatrial septum in relation to surrounding cardiac structures, thus facilitating a safe Transseptal puncture. However, it adds discomfort and stress to the patients, aside from the possible risk of esophageal injury and lung aspiration. Because of the disadvantages and limitations of transthoracic and transesophageal echocardiography, we investigated the feasibility and usefulness of intracardiac echocardiography using a commercially available 10 MHz over-the-wire intravascular ultrasound Catheter to perform Transseptal puncture. Seven patients with symptomatic severe mitral stenosis were studied including 2 men and 5 women aged 36 to 55 years (mean 45). Informed consent was obtained from each patient. After diagnostic Catheterization, a IOFr 10 MHz ultrasound Catheter was inserted into the superior vena cava over a preplaced 0.025inch guidewire through a IlFr sheath in the lef femoral vein. The Catheter was interfaced with a real-time ultrasound imaging system (CVIS Inc., Sunnyvale, California). The ultrasound Catheter was withdrawn caudally from the superior vena cava to the midright atrium to image the interatrial septum and the atria (Figure IA, lef panel). A 7Fr Mullins Transseptal Catheter with a Brockenbrough needle was inserted through the right femoral vein and its tip was set at the optimal Transseptal puncture site. The latter was determined under f?on-tal fluoroscopic view according to landmark selection guidelines previously described.‘a5 The position of the Catheter ultrasound transducer was adjusted so that the
David R. Holmes - One of the best experts on this subject based on the ideXlab platform.
-
Echocardiography in the invasive laboratory: utility of two-dimensional echocardiography in performing Transseptal Catheterization.
Mayo Clinic proceedings, 1998Co-Authors: David G. Hurrell, Rick A. Nishimura, John D. Symanski, David R. HolmesAbstract:• Objective To evaluate the potential utility of transthoracic two-dimensional echocardiography as an aid in the technique of Transseptal Catheterization. • Design We performed a prospective study of 58 patients (29 men and 29 women; mean age, 64.2 years) referred for cardiac Catheterization, in whom a systematic approach was used with selective application of two-dimensional echocardiography. • Material and Methods The study group of 58 patients had the following diagnoses: mitral stenosis in 17, hypertrophic cardiomyopathy in 13, dilated cardiomyopathy in 13, aortic stenosis in 13, and prosthetic valve dysfunction and pulmonary hypertension in 1 each. With use of only fluoroscopic guidance, initial gentle pressure on the dilator alone was attempted for left atrial access. If the Catheter resisted entry into the left atrium, two-dimensional echocardiography was performed to assess the Catheter's position relative to the atrial septum, and adjustments were made accordingly. Transseptal puncture with a Brockenbrough needle was performed only after confirmation of the Catheter position at the region of the fossa ovalis with two-dimensional echocardiography. • Results The Catheterization procedure was performed without complication in all 58 patients; the mean time to Catheter placement was 5.6 ± 3.5 minutes (range, 3 to 20). Two-dimensional echocardiography was used in 33 patients (57%) when left atrial access was not obtained. On the basis of echocardiographic images, the Transseptal Catheter had to be repositioned in 16 of these 33 patients (48%). • Conclusion Two-dimensional echocardiography offers value in demonstrating Catheter position during Transseptal Catheterization and may be used in some patients to ensure Transseptal puncture at the region of the fossa ovalis.
Jui-sung Hung - One of the best experts on this subject based on the ideXlab platform.
-
Usefulness of intracardiac echocardiography in Transseptal puncture during percutaneous transvenous mitral commissurotomy.
The American journal of cardiology, 1993Co-Authors: Jui-sung Hung, Kou-ho Yeh, Sarah Chua, Yu-chang ChenAbstract:P ercutaneous transvenous mitral commissurotomy has become an effective and safe alternative to surgical treatment in well-selected patients.’ Transseptal Catheterization is a vital component of the procedure. Because of its technical complexity and difEculty, Transseptal Catheterization is recommended to be restricted to highvolume Catheterization laboratories equipped with biplane fluoroscopy.2 Recently, usefulness of transthoracic 2dimensional echocardiography and transesophageal echocardiography‘t in guiding Transseptal puncture has been reported. However, transthoracic 2-dimensional echocardiography may be limited by suboptimal interatria1 septum visualization. In addition, placement of the transducer on the patient’s chest not only interferes with the fluoroscopic images, but also poses a radiation hazard to the echocardiographer. Space limitations in the Catheterization laboratory and a need to preserve a sterile field also make this examination cumbersome. Transesophageal echocardiography allows high-quality visualization of the interatrial septum in relation to surrounding cardiac structures, thus facilitating a safe Transseptal puncture. However, it adds discomfort and stress to the patients, aside from the possible risk of esophageal injury and lung aspiration. Because of the disadvantages and limitations of transthoracic and transesophageal echocardiography, we investigated the feasibility and usefulness of intracardiac echocardiography using a commercially available 10 MHz over-the-wire intravascular ultrasound Catheter to perform Transseptal puncture. Seven patients with symptomatic severe mitral stenosis were studied including 2 men and 5 women aged 36 to 55 years (mean 45). Informed consent was obtained from each patient. After diagnostic Catheterization, a IOFr 10 MHz ultrasound Catheter was inserted into the superior vena cava over a preplaced 0.025inch guidewire through a IlFr sheath in the lef femoral vein. The Catheter was interfaced with a real-time ultrasound imaging system (CVIS Inc., Sunnyvale, California). The ultrasound Catheter was withdrawn caudally from the superior vena cava to the midright atrium to image the interatrial septum and the atria (Figure IA, lef panel). A 7Fr Mullins Transseptal Catheter with a Brockenbrough needle was inserted through the right femoral vein and its tip was set at the optimal Transseptal puncture site. The latter was determined under f?on-tal fluoroscopic view according to landmark selection guidelines previously described.‘a5 The position of the Catheter ultrasound transducer was adjusted so that the
Tondo C. - One of the best experts on this subject based on the ideXlab platform.
-
Fossa ovalis radiofrequency perforation in a difficult case of conventional Transseptal puncture for atrial fibrillation ablation
2008Co-Authors: Casella M., Dello Russo A., Pelargonio G., Martino A., De Paulis S., Zecchi P., Bellocci F., Tondo C.Abstract:A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-procedure transthoracic and transoesophageal echocardiography and cardiac computed tomography examinations showed a normal interatrial septum and fossa ovalis anatomy. Access to left atrium was initially planned using a conventional Transseptal needle puncture. During the procedure, several consecutive attempts in conjunction with intracardiac echocardiography support, failed to cross the septum. The procedure was then successfully carried out using a specifically designed radiofrequency Transseptal Catheter. © 2007 Springer Science+Business Media, LLC
