Bidoggia H, Maciel J P, Alvarez J A
Cátedra de Cardioangiología, Universidad del Salvador, Buenos Aires, Republica Argentina.
Cathet Cardiovasc Diagn. 1991 Nov;24(3):221-5. doi: 10.1002/ccd.1810240318.
One of the major difficulties in left heart catheterization through the interatrial septum is to ensure that the Brockenbrough needle tip is correctly laid on the fossa ovalis floor (FOF), which is the only area where the puncture must be done. The difficulties may be enhanced in patients with atrial enlargement and subsequent distortion of the anatomical structures. In order to reduce the hazards of the septal puncture, an electrocardiographic mapping of the right atrial endocardium was performed using the Brockenbrough needle as an exploratory electrode in a group of 20 patients. When the tip of the needle was laid against the FOF, the endoatrial electrocardiogram (EAE) registered a slight or no injury curve, even when the pressure was tight enough to perforate the septum. On the contrary, the pressure on any other area of the muscular septum or atrial walls elicited a bizarre monophasic injury curve. The peculiar electrocardiographic response of the FOF to the pressure exerted by the Brockenbrough needle tip was a valuable aid to identify the area where the transseptal puncture must be done. In addition, the sudden changes in the P wave morphology immediately after the septal perforation, provided the first clue that the left atrium has been reached.
经房间隔进行左心导管插入术的主要困难之一是确保布罗肯布罗针尖端正确置于卵圆窝底部（FOF），这是唯一必须进行穿刺的区域。对于存在心房扩大及随后解剖结构变形的患者，困难可能会增加。为降低间隔穿刺的风险，在一组20例患者中，以布罗肯布罗针作为探测电极对右心房内膜进行了心电图标测。当针尖端置于FOF时，即使压力足以穿透间隔，心内膜心电图（EAE）记录的是轻微损伤曲线或无损伤曲线。相反，在肌性间隔或心房壁的任何其他区域施加压力会引发奇异的单相损伤曲线。FOF对布罗肯布罗针尖端施加压力的特殊心电图反应是确定必须进行经间隔穿刺区域的宝贵辅助手段。此外，间隔穿孔后P波形态的突然变化，是已到达左心房的首个线索。
