High-risk transseptal puncture in a patient with a “pancake” deformity in the left atrium caused by descending aorta displacement

Takuro Nishimura, MD; Seiji Fukamizu, MD; Noriko Matsushita, MD; Rintaro Hojo, MD; Takekuni Hayashi, MD; Tomomi Abe, MD; Kota Komiyama, MD; Yasuhiro Tanabe, MD; Tamotsu Tejima, MD, PhD; Harumizu Sakurada, MD, PhD; Mitsuhiro Nishizaki, MD, PhD; Masayasu Hiraoka, MD, PhD

doi:10.1016/j.joa.2012.03.015

Journal of Arrhythmia (Aug 2012)

High-risk transseptal puncture in a patient with a “pancake” deformity in the left atrium caused by descending aorta displacement

Takuro Nishimura, MD,
Seiji Fukamizu, MD,
Noriko Matsushita, MD,
Rintaro Hojo, MD,
Takekuni Hayashi, MD,
Tomomi Abe, MD,
Kota Komiyama, MD,
Yasuhiro Tanabe, MD,
Tamotsu Tejima, MD, PhD,
Harumizu Sakurada, MD, PhD,
Mitsuhiro Nishizaki, MD, PhD,
Masayasu Hiraoka, MD, PhD

Affiliations

Takuro Nishimura, MD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Seiji Fukamizu, MD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Noriko Matsushita, MD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Rintaro Hojo, MD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Takekuni Hayashi, MD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Tomomi Abe, MD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Kota Komiyama, MD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Yasuhiro Tanabe, MD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Tamotsu Tejima, MD, PhD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Harumizu Sakurada, MD, PhD: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-ku, Tokyo 150-0013, Japan
Mitsuhiro Nishizaki, MD, PhD: Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
Masayasu Hiraoka, MD, PhD: Tokyo Medical and Dental University, Japan

DOI: https://doi.org/10.1016/j.joa.2012.03.015
Journal volume & issue: Vol. 28, no. 4
pp. 250 – 253

Abstract

Read online

Catheter ablation via the transseptal approach has recently become a widely performed technique for treating atrial fibrillation (AF). However, fluoroscopic imaging provides limited anatomic guidance for the left atrial structure. We describe the case of a 78-year-old man who was referred to our hospital for pulmonary vein isolation for symptomatic paroxysmal AF. He had a history of pulmonary tuberculosis for which he had undergone a right upper lobectomy. A “pancake” deformity of the left atrium (LA) was observed using 64-slice multislice computed tomography. We performed a transseptal puncture by using real-time three-dimensional transesophageal echocardiography (RT3D-TEE) in combination with fluoroscopic imaging, without any complications. Although transseptal puncture can be performed without echocardiographic guidance in most patients, in our patient, RT3D-TEE proved to be a very helpful imaging technique to access the LA.

Published in Journal of Arrhythmia

ISSN: 1880-4276 (Print); 1883-2148 (Online)
Publisher: Wiley
Country of publisher: Australia
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://onlinelibrary.wiley.com/journal/18832148

About the journal

Abstract

Keywords