scholarly journals Intracardiac echocardiography for transseptal puncture. A guide for cardiac electrophysiologists

2019 ◽  
Vol 21 (2) ◽  
pp. 183 ◽  
Author(s):  
Radu Rosu ◽  
Gabriel Cismaru ◽  
Lucian Muresan ◽  
Mihai Puiu ◽  
Gabriel Gusetu ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cardiac Catheterization ◽  
Phased Array ◽  
Interventional Cardiology ◽  
Interatrial Septum ◽  
Intracardiac Echocardiography ◽  
Transseptal Puncture ◽  
Direct Visualization ◽  
Left Heart ◽  
Mechanical Transducer

The key to a successful catheterization of the left heart chambers is the safe transseptal puncture. Intracardiac echocardiography (ICE) is an attractive tool used in cardiac catheterization and electrophysiology labs to provide detailed images thatcan facilitate transseptal puncture. ICE permits a direct visualization of the endocardium and precisely locates the needle and the sheath against the interatrial septum. Two different ICE catheters are available: a phased array and a mechanical transducer, both being currently used in clinical practice. This paper describes the technique used for guiding transseptal puncture with ICE. Due to its advantages, ICE has currently become an important tool used to maximize the safety of the transseptal puncture and increase efficacy of interventional cardiology procedures.

scholarly journals Safety of Transseptal Puncture for Access to the Left Atrium in Infants and Children

2021 ◽  
Author(s):  
Matthias J. Müller ◽  
David Backhoff ◽  
Heike E. Schneider ◽  
Jana K. Dieks ◽  
Julia Rieger ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Heart Defects ◽  
Standard Procedure ◽  
Interatrial Septum ◽  
Infants And Children ◽  
Transseptal Puncture ◽  
Left Heart ◽  
Urgent Surgery ◽  
In Infants And Children ◽  
Small Pericardial Effusion

AbstractTransseptal puncture (TSP) is a standard procedure to obtain access to the left heart. However, data on TSP in infants and children particularly with congenital heart defects (CHD) is sparse. Safety and efficacy of TSP in infants and children < 18 years with normal cardiac anatomy and with CHD were assessed. 327 TSP were performed in a total of 300 individuals < 18 years from 10/2002 to 09/2018 in our tertiary pediatric referral center. Median age at TSP was 11.9 years (IQR 7.8–15; range: first day of life to 17.9 years). 13 subjects were < 1 year. Median body weight was 43.8 kg (IQR 26.9–60; range: 1.8–121 kg). CHD was present in 28/327 (8.6%) procedures. TSP could be successfully performed in 323/327 (98.8%) procedures and was abandoned in 4 procedures due to imminent or incurred complications. Major complications occurred in 4 patients. 3 of these 4 subjects were ≤ 1 year of age and required TSP for enlargement of a restrictive atrial septal defect in complex CHD. Two of these babies deceased within 48 h after TSP attempt. The third baby needed urgent surgery in the cath lab. Pericardial effusion requiring drainage was noted in the forth patient (> 1 year) who was discharged well later. Minor complications emerged in 5 patients. The youngest of these individuals (0.3 years, 5.8 kg) developed small pericardial effusion after anterograde ballon valvuloplasty for critical aortic stenosis. The remaining 4/5 patients developed small pericardial effusion after ablation of a left-sided accessory atrioventricular pathway (6.1–12.2 years, 15.6–34.0 kg). TSP for access to the left heart was safe and effective in children and adolescents > 1 year of age. However, TSP was a high-risk procedure in small infants with a restrictive interatrial septum with need for enlargement of interatrial communication.

Abstract 2241: Direct Visualization Of The Fossa Ovalis For Transeptal Puncture: In Vivo Evaluation Of The IRIS Catheter In A Porcine Model

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Aravinda Thiagalingam ◽  
Andre d’Avila ◽  
Lori Foley ◽  
David Miller ◽  
Chris Rothe ◽  
...  
Keyword(s):  
Porcine Model ◽  
De Novo ◽  
Interatrial Septum ◽  
Intracardiac Echocardiography ◽  
Atrial Septum ◽  
Post Mortem ◽  
Direct Visualization ◽  
Atrial Wall ◽  
In Vivo Evaluation

Introduction: Transeptal puncture is required for many interventional procedures but has a serious complication rate of ~1%. The primary risk of the procedure is related to mis-identification of the interatrial septum resulting in inadvertant puncture of the aorta or the atrial wall into the pericardium. We have investigated the utility of a catheter that allows direct visualization of the fossa ovalis to correctly position the transseptal needle at the interatrial septum. Methods: This study included 6 swine. The IRIS catheter (Voyage Medical, Campbell, CA) enables direct visualization using a cone-shaped hood into which saline is infused to exclude blood. In 4/6 animals, intracardiac echocardiography was used to visualize, but not guide, the transeptal puncture; there was no visible tenting of the septum. After transeptal puncture was performed the IRIS catheter was used to directly visualize and cannulate the puncture sites. Results: In 5 animals, transeptal puncture was successfully performed repeatedly (2–4 punctures/animal), and a .035 guidwire passed into the left atrium. IRIS could also guide cannulation of previous puncture in these animals. In 1 animal, visualization could not be performed because the atrial septum was lacerated during an attempt at left atrial visualization via a patent foramen ovale. Pericardial effusion was only observed in this latter animal on post-mortem exam. IRIS visualization of the atrial septum correlated well with the pathological specimen (see Figure ). Conclusion: The IRIS catheter allows direct in vivo visualization of the interatrial septum to guide de novo transeptal puncture or cannulation of previous punctures. Top: A cascade of in vivo IRIS images of transeptal puncture holes (arrows) and a PFO Bottom: Corresponding post mortem speciman

A Soft Robotic Simulator for Transseptal Puncture Training

2020 ◽  
Author(s):  
Nicholas A. Thompson ◽  
Abraham G. Kocheril ◽  
Elizabeth T. Hsiao-Wecksler ◽  
Girish Krishnan
Keyword(s):  
Right Atrium ◽  
Force Feedback ◽  
Interatrial Septum ◽  
Intracardiac Echocardiography ◽  
Transseptal Puncture ◽  
Tissue Properties ◽  
Increased Risk ◽  
Manual Skills ◽  
The Right ◽  
Robotic Simulator

Abstract Transseptal puncture (TP) is the technique used to access the left atrium of the heart from the right atrium via the interatrial septum in increasingly common catheter-based procedures such as atrial fibrillation ablation. Through repetition, experienced TP operators develop manual skills to manipulate the transseptal catheter assembly inside the right atrium to their target on the fossa ovalis. New operators currently train on actual patients to develop this skill, resulting in increased risk of dangerous complications. To create low-risk training opportunities for new TP operators, we are developing a Soft Active Transseptal Puncture Simulator (SATPS), designed to match the dynamics, kinetostatics, and visualization of the heart during TP. The SATPS includes three main subsystems: (i) An anatomically accurate soft right atrium, fitted with pneumatic artificial muscles, mimics the dynamics of the heart felt by the operator through the catheter assembly. (ii) A replaceable, puncturable fossa ovalis simulates the tissue properties of the real fossa to provide accurate kinetostatic force feedback during tenting and puncture. (iii) A simulated intracardiac echocardiography environment gives the user live visual feedback representative of an ultrasound monitor during an actual TP procedure. The SATPS is an ongoing project, with validation and design improvements forthcoming.

Use of Intracardiac Echocardiography in Cardiac Electrophysiology

2013 ◽  
pp. 65-74
Author(s):  
Paul A. Friedman ◽  
Samuel J. Asirvatham
Keyword(s):  
Intravascular Ultrasound ◽  
Cardiac Electrophysiology ◽  
Phased Array ◽  
Intracardiac Echocardiography ◽  
Transseptal Puncture ◽  
Tissue Penetration ◽  
Intracardiac Ultrasound ◽  
High Resolution Images ◽  
Whole Heart Imaging ◽  
Whole Heart

Intracardiac echocardiography is increasingly used during invasive electrophysiology procedures. Common applications include guiding transseptal puncture, assessing potential complications, and identifying structures invisible under fluoroscopy. It is important to distinguish intravascular ultrasound from intracardiac ultrasound. Intravascular ultrasound uses high-frequency transducers that provide excellent high-resolution images but have limited tissue penetration. Intracardiac imaging uses lower frequencies, increasing tissue penetration to 14 cm and permitting “whole heart” imaging. The purpose of this brief introduction is to provide practical points of reference for use of intracardiac echocardiography and orientation to the images that follow in the remainder of the book. Thus, only images from the phased-array system are included.

scholarly journals The beginnings of cardiac catheterization and the resulting impact on pulmonary medicine

2017 ◽  
Vol 313 (4) ◽  
pp. L651-L658 ◽  
Author(s):  
John B. West
Keyword(s):  
Blood Flow ◽  
Cardiac Catheterization ◽  
Nobel Prize ◽  
Venous Blood ◽  
Interventional Cardiology ◽  
Primary Objective ◽  
Mixed Venous Blood ◽  
Pulmonary Medicine ◽  
Fick Principle ◽  
The Right

The early history of cardiac catheterization has many interesting features. First, although it would be natural to assume that the procedure was initiated by cardiologists, two of the three people who shared the Nobel Prize for the discovery were pulmonologists, while the third was a urologist. The primary objective of the pulmonologists André Cournand and Dickinson Richards was to obtain mixed venous blood from the right heart so that they could use the Fick principle to calculate total pulmonary blood flow. Cournand’s initial catheterization studies were prompted by his reading of an account by Werner Forssmann, who catheterized himself 12 years before. His bold experiment was one of the most bizarre in medical history. In the earliest studies that followed, Cournand and colleagues first passed catheters into the right atrium, and then into the right ventricle, and finally, the pulmonary artery. At the time, the investigators did not appreciate the significance of the low vascular pressures, nor that what they had done would revolutionize interventional cardiology. Within a year, William Dock predicted that there would be a very low blood flow at the top of the upright lung, and he proposed that this was the cause of the apical localization of pulmonary tuberculosis. The fact that the pulmonary vascular pressures are very low has many implications in lung disease. Cardiac catheterization changed the face of investigative cardiology, and its instigators were awarded the Nobel Prize in 1956.

Abstract 590: Evaluation of the Effects of Cardiac Arrest and CPR Using Intracardiac Echocardiography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Martin C Burke ◽  
Kiam K Lim ◽  
Matthew Smelley ◽  
John F Beshai ◽  
Susan S Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Thrombus Formation ◽  
Venous Access ◽  
Intracardiac Echocardiography ◽  
Direct Visualization ◽  
Chest Compressions ◽  
Right Heart ◽  
The Right ◽  
Current Energy

For every minute of cardiac arrest, mortality increases by 10%. Still, the variablity of meaningful neurologic survival suggests multiple factors involved in the hypoxia and encephalopathy of cardiac arrest (CA). We studied the cardiac chamber environment during ventricular fibrillation and asystole using direct ultrasound visualization using real-time intracardiac echocardiography (ICE). Four pigs were studied under general anesthesia per protocol. Venous access was obtained for catheter placement within the right heart. A bipolar paciing wire was placed into the right ventricle. A 10 French Acuson ICE catheter was placed into the right atrium using fluoroscopy. Baseline images were obtained. Ventricular fibrillation was induced using direct current energy. 30 minutes of ventricular fibrillation and terminal asystole was observed. Chest compressions were delivered intermittently with direct visualization of effects. Intra-chamber thrombus was quantified by chamber and by arrhythmia. All subjects began to form intracardiac thrombus within 1 minute of ventricular fibrillation. The persistence of sinus rhythm during fibrillation prevented thrombus formation in the atria and the basal portions of both ventricles. The thrombus was predominantly in the right heart within the first 4 minutes of CA. ICE documents that chest compressions completely clear the thrombus when delivered within the first five minutes of CA. Asystole led to more solidified thrombus that was more difficult to clear. Thrombus formation during CA is marked and may be a predominant reason for neurologic damage post resuscitation. Asystole was associated with complete chamber thrombus in comparison to ventricular fibrillation.

Outcomes using a clinical practice pathway for the management of pulse loss following pediatric cardiac catheterization

2014 ◽  
Vol 85 (1) ◽  
pp. 111-117 ◽  
Author(s):  
Andrew C. Glatz ◽  
Rachel Keashen ◽  
Julie Chang ◽  
Lisa-Ann Balsama ◽  
Yoav Dori ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cardiac Catheterization ◽  
Pediatric Cardiac Catheterization
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