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.