1/15. Transseptal puncture guided by intracardiac echocardiography during percutaneous transvenous mitral commissurotomy in patients with distorted anatomy of the fossa ovalis.Positioning of the transseptal needle during percutaneous transvenous mitral commissurotomy (PTMV) can become a difficult and risky procedure when distortion of the interatrial septum exists. We present two cases where intracardiac echocardiography (ice) facilitated the transseptal puncture in the presence of bulging of the fossa ovalis into the right atrium.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/15. Successful inoue balloon valvotomy in a difficult case of mitral stenosis using multiple modifications of technique: alternative method for loop formation of the Inoue balloon catheter.Transseptal puncture was accomplished with difficulty at an unfavorable site in a case of severe mitral stenosis with distorted atrial and septal anatomy. Septal balloon entrapment could not be avoided during attempts to cross the mitral valve using the standard technique. This problem was circumvented by resorting to the loop method and the left ventricle was entered first with a guidewire, which then supported the balloon catheter. Successful mitral valve dilatation could thus be performed. A simple alternative method that was used to form the Inoue balloon catheter into a loop is also described.- - - - - - - - - - ranking = 0.2keywords = puncture (Clic here for more details about this article) |
3/15. Transcatheter creation of atrial septal perforation using a radiofrequency transseptal system: novel approach as an alternative to transseptal needle puncture.Indications for the transseptal approach to the left side of the heart have recently broadened, as it provides a therapeutic access for both left-sided catheter ablation and also percutaneous transvenous valvular intervention. Despite rising demand for transseptal procedures, the technique and device used for this purpose have remained essentially unchanged over the past 4 decades. The possibilities of failure of puncturing distorted and thickened atrial septal tissue or risks of complications related to cardiac perforation remain limitations of the technique. A new radiofrequency catheter provides an alternative approach to create a controlled transseptal perforation. We applied this technique to a series of patients and evaluated its feasibility as an alternative to conventional transseptal needle puncture.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/15. Residual atrial septal perforation after percutaneous transvenous mitral commissurotomy with Inoue balloon catheter.To estimate the incidence of residual atrial septal perforation (ASP) following percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter and to examine the factors contributing to ASP, we studied 46 patients with mitral stenosis undergoing PTMC. Residual ASP was evaluated by Doppler color flow imaging 1 day after PTMC, and was detected in 7 out of 46 patients (15.2%). We examined the relationship between the development of ASP (ASP ) and the age of the patient, the left atrial dimension before PTMC, the mean pressure difference between left and right atrium after PTMC, and the duration of the procedure from atrial septal puncture by the Brockenbrough method to balloon inflation. There was a good correlation between the development of residual ASP and the duration of the procedure (ASP , 51.0 /- 34.0 minutes; without ASP, 24.6 /- 16.2 minutes; p less than 0.01). However, there was no significant correlation between the development of ASP and other factors. In the follow-up study, ASP disappeared in four patients within 3 months. ASP persisted in two patients for 1 year after PTMC. However, the shunt in these two patients was clinically insignificant. These data suggest that residual ASP may depend on the duration of the procedure, and that most cases of ASP disappear within 1 year after PTMC.- - - - - - - - - - ranking = 0.2keywords = puncture (Clic here for more details about this article) |
5/15. Retrograde pulmonary vein wedge angiography: a new technique.A new technique of pulmonary vein wedge angiography to delineate pulmonary artery anatomy is described. Conventional pulmonary vein wedge angiography requires an interatrial communication--natural or created by a transseptal puncture. In retrograde pulmonary vein wedge angiography, the left atrium and pulmonary veins are entered from arterial route using a specially designed catheter. This technique can be specially utilized for patients in whom there is no interatrial communication.- - - - - - - - - - ranking = 0.2keywords = puncture (Clic here for more details about this article) |
6/15. International physiology. Development of left atrial thrombus following attempted percutaneous mitral valvuloplasty.In this report, we describe two cases of attempted mitral valvuloplasty using an Inoue balloon in which left atrial thrombus was not present before transseptal puncture but developed within minutes of the puncture in one, and within 1 mo in the other, despite systemic anticoagulation.- - - - - - - - - - ranking = 0.4keywords = puncture (Clic here for more details about this article) |
7/15. Percutaneous balloon valvuloplasty in mirror-image dextrocardia and rheumatic mitral stenosis.A 28-year-old woman with mirror-image dextrocardia and severe rheumatic mitral stenosis underwent successful percutaneous balloon mitral valvuloplasty (PBMV). Standard technique was altered to include transseptal catheterization via the left femoral vein and inter-atrial septal puncture with the transseptal needle rotated to a 7 o'clock position. The predilatation transmitral gradient (mean) of 16 mmHg decreased to 5 mmHg following PBMV. The valve area improved from 1.0 cm2 to 2.6 cm2. There were no complications. This case illustrates that transseptal catheterization can be accomplished safely in patients with unusual cardiac anatomy and mitral valvuloplasty can be performed in patients with mirror-image dextrocardia and rheumatic mitral stenosis.- - - - - - - - - - ranking = 0.2keywords = puncture (Clic here for more details about this article) |
8/15. Bidirectional shunt through a residual atrial septal defect after percutaneous transvenous mitral commissurotomy.A residual atrial septal defect with bidirectional shunt was detected by transesophageal echocardiography in a 28-year-old man 3 years after percutaneous transluminal mitral commissurotomy (PTMC) with the antegrade transseptal technique. He had had severe mitral stenosis, pulmonary hypertension, and tricuspid regurgitation before the procedure. The result of PTMC was suboptimal, the pulmonary hypertension regressed only partially, and the tricuspid regurgitation remained severe. These factors contributed to the bidirectional shunt. A bidirectional shunt is known to be associated with systemic desaturation and a higher risk of paradoxical embolization and brain abscess. When PTMC is considered in patients with pulmonary hypertension and tricuspid regurgitation, a retrograde left ventricular approach with or without transseptal puncture can avoid the atrial septotomy, decrease the incidence of significant shunt, and should be a rational alternative.- - - - - - - - - - ranking = 0.2keywords = puncture (Clic here for more details about this article) |
9/15. Percutaneous transvenous mitral commissurotomy in patients with severe kyphoscoliosis.Because transseptal catheterization is felt to be contraindicated in patients with severe kyphoscoliosis, there have been no reports of percutaneous transvenous mitral commissurotomy performed in such patients. This report describes percutaneous transvenous mitral commissurotomy in three patients with severe thoracic kyphoscoliosis, with special emphasis on the transseptal puncture technique. Biplane right atrial angiography and the contrast septal flush method are very useful in landmark selection for a safe transseptal puncture.- - - - - - - - - - ranking = 0.4keywords = puncture (Clic here for more details about this article) |
10/15. Combined percutaneous balloon mitral valvotomy and coronary angioplasty with stent implantation.A patient with symptomatic pliable mitral stenosis and a significant lesion in the right coronary artery underwent combined interventional procedures during a single session. After an uneventful transseptal puncture that allowed full anticoagulation with heparin, a percutaneous transluminal coronary angioplasty was performed, yielding an unsatisfactory result and necessitating stent implantation. Thereafter, mitral stenosis was relieved by percutaneous balloon valvotomy. The specific problems arising from the combination of the two procedures are discussed.- - - - - - - - - - ranking = 0.2keywords = puncture (Clic here for more details about this article) |
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