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Cardiology Research and Practice
Volume 2015, Article ID 174051, 4 pages
Research Article

A Proposed Maneuver to Guide Transseptal Puncture Using Real-Time Three-Dimensional Transesophageal Echocardiography: Pilot Study

1Adult Cardiology Department, Prince Sultan Cardiac Center, Al-Hassa, Saudi Arabia
2Cardiology Department, Al-Azhar University, Cairo, Egypt

Received 20 April 2015; Revised 17 May 2015; Accepted 19 May 2015

Academic Editor: Terrence D. Ruddy

Copyright © 2015 Hani M. Mahmoud et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Supplementary Material

Video legend: RATLe-90 Maneuver; Starting from the 2D-mid-esophageal 90 ͦ bi-caval view, activate the 3D-zoom mode. The zoom box should be optimized to include the openings of the superior vena cava (SVC), inferior vena cava (IVC) & Aortic root (Ao), with enough depth to include the whole inter-atrial septum (IAS) from both atrial perspectives excluding extra atrial tissues. Then, acquiring this volume will give us a truncated volume with the SVC pointing to the right of the screen (arrow-head), IVC pointing to the left. Then Rotate-Anticlockwise this volume for 90ͦ to have the SVC pointing superiorly (arrow-head) & the IVC pointing inferiorly. Then Tilt-Left this volume for 90ͦ to have the anatomically oriented enface view of the IAS from the right atrial (RA) perspective. Reducing the gain will remove the blood signals and allow clear identification of the SVC opening, IVC opening, Eustachian valve (EV), Coronary Sinus opening (CS) & will cause dropout artifact in the thin area of the fossa ovalis (arrow-head) that will help determining its location to guide septal puncture.

  1. Supplementary Material