TRANSSEPTAL CATHETERIZATION WITH TRANSESOPHAGEAL GUIDANCE IN HIGH-RISK PATIENTS

Atrial transseptal catheterization is usually performed with fluorosco pic guidance of the needle. We report our experience with both fluoros copic and transesophageal guidance in patients who would otherwise hav e been at risk by using only fluoroscopy. A total of eleven procedures were performed during a 4 year period. The relative contraindications (some patients had several contraindications) included prior valve re placement (5 patients), prior myocardial revascularization (4 patients ), severe dilatation of the left atrium (4 patients), severe dilatatio n. of the ascending aorta (4 patients), and kyphoscoliosis (3 patients ). All eleven patients had the transesophageal guided transseptal cath eterization performed without complications and without significantly prolonging the procedure. The results of this preliminary, smalt, and retrospective study suggest that transesophageal echocardiography may enhance the safety of transseptal catheterization. in high risk patien ts. Further prospective studies are needed.