Transseptal Catheterization
Transseptal catheterization is increasingly performed as the number of atrial fibrillation catheter ablation procedures increases and as new percutaneous valve procedures that require left atrial access are developed. Successful transseptal catheterization does not necessarily require ultrasound guidance, but the use of TEE and ICE can be useful in cases with challenging anatomy, during redo procedures, or to guide site-specific targets for different procedures. It likely also improves the safety of the average procedure. The 4D ICE catheter used in this series provided outstanding 3D views of the fossa ovalis and was useful to provide 3D orientation of the transseptal needle relative to neighboring structures to guide safe passage of the needle. Use of the 4D ICE catheter during a particularly challenging transseptal catheterization in a patent with a preexisting atrial septal defect occluder device illustrates how volumetric imaging and the ability to digitally steer the image can help to ensure safe and successful transseptal catheterization in challenging cases. Whether the digital steering and 4D imaging offer additional value beyond 2D ICE during transseptal catheterization remains to be determined.