Echocardiography in the invasive laboratory: Utility of two-dimensional echocardiography in performing transseptal catheterization

Objective: To evaluate the potential utility of trans-thoracic 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 systemic 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 flouroscopic guidance, initial gentle pressure on the ailator 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%). Conclusions: 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.