Need for TEE guidance for septal puncture during BMV

Need for TEE guidance for septal puncture during BMV

Usually only fluroscopic guidance is required during trans-septal puncture to enter the left atrium during balloon mitral valvotomy (BMV). But during certain situations, it may be advisable to have guidance with trans-esophageal echocardiography (TEE). When the left atrium is grossly dilated, anatomical landmarks on fluroscopy may not be accurate. Other situations are aneurysmal atrial septum, prior atrial septal surgery or distortion of the anatomy by scoliosis or previous pneumonectmy. In these situations, fluroscopic guidance may not be sufficient to get an accurate puncture at the fossa ovalis and simultaneous echo guidance – either trans-esophageal or intra-cardiac (ICE – intra-cardiac echocardiography), may give better visualization of the ideal puncture site.

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