Gonzalez M D, Otomo K, Shah N, Arruda M S, Beckman K J, Lazzara R, Jackman W M
Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
J Interv Card Electrophysiol. 2001 Mar;5(1):89-95. doi: 10.1023/a:1009818210563.
Transseptal left heart catheterization has been performed as an alternative to the retrograde approach since 1958. However, this procedure can result in life-threatening complications, some of which may occur because of insufficient anatomical landmarks. Accordingly, we sought to assess the safety and efficacy of a new transseptal left heart catheterization technique designed for ablation procedures. Specifically, we examined whether electrode catheters could be used as anatomical landmarks, permitting identification of the aortic root and other critical structures.
One hundred and eight consecutive patients underwent transseptal left heart catheterization under biplane fluoroscopy during catheter ablation. Electrode catheters positioned in the right atrial appendage, His bundle region, and coronary sinus were used as anatomical landmarks to guide the transseptal unit to the fossa ovalis. The angles of the right anterior and left anterior oblique projections were selected in each patient based on the orientation of the His bundle and coronary sinus catheters. Transseptal left heart catheterization was successfully performed in all patients without complications. In contrast to previous reports, the direction of the needle at the successful puncture site in the last 96 patients varied substantially: 2 o'clock in 13 patients (13 %); 3 o'clock in 43 patients (45 %); and 4 o'clock in 40 patients (42 %).
The use of electrode catheters as anatomical landmarks and biplane fluoroscopy facilitates transseptal catheterization. This approach can be used safely during catheter ablation procedures.
自1958年以来，经房间隔左心导管插入术已被用作逆行途径的替代方法。然而，该操作可能导致危及生命的并发症，其中一些可能由于解剖标志不足而发生。因此，我们试图评估一种专为消融手术设计的新的经房间隔左心导管插入术技术的安全性和有效性。具体而言，我们研究了电极导管是否可用作解剖标志，以识别主动脉根部和其他关键结构。
108例连续患者在导管消融期间在双平面荧光透视下接受经房间隔左心导管插入术。将置于右心耳、希氏束区域和冠状窦的电极导管用作解剖标志，以引导经房间隔装置至卵圆窝。根据希氏束和冠状窦导管的方向为每位患者选择右前斜位和左前斜位投影角度。所有患者均成功进行了经房间隔左心导管插入术，无并发症发生。与先前的报告不同，最近96例患者成功穿刺部位的针方向差异很大：13例患者为2点方向（13%）；43例患者为3点方向（45%）；40例患者为4点方向（42%）。
使用电极导管作为解剖标志和双平面荧光透视有助于经房间隔导管插入术。这种方法在导管消融手术期间可安全使用。
