TRANSSEPTAL LEFT HEART CATHETERIZATION - USEFULNESS OF THE INTRACAVITARY ELECTROCARDIOGRAM IN THE LOCALIZATION OF THE FOSSA-OVALIS

被引:10
作者
BIDOGGIA, H [1 ]
MACIEL, JP [1 ]
ALVAREZ, JA [1 ]
机构
[1] UNIV SALVADOR,CATEDRA CARDIOANGIOL,TUCUMAN 1845,RA-1050 BUENOS AIRES,ARGENTINA
来源
CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS | 1991年 / 24卷 / 03期
关键词
TRANSSEPTAL CATHETERIZATION; ENDOATRIAL ELECTROCARDIOGRAM;
D O I
10.1002/ccd.1810240318
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
One of the major difficulties in left heart catheterization through the interatrial septum is to ensure that the Brockenbrough needle tip is correctly laid on the fossa ovalis floor (FOF), which is the only area where the puncture must be done. The difficulties may be enhanced in patients with atrial enlargement and subsequent distortion of the anatomical structures. In order to reduce the hazards of the septal puncture, an electrocardiographic mapping of the right atrial endocardium was performed using the Brockenbrough needle as an exploratory electrode in a group of 20 patients. When the tip of the needle was laid against the FOF, the endoatrial electrocardiogram (EAE) registered a slight or no injury curve, even when the pressure was tight enough to perforate the septum. On the contrary, the pressure on any other area of the muscular septum or atrial walls elicited a bizarre monophasic injury curve. The peculiar electrocardiographic response of the FOF to the pressure exerted by the Brockenbrough needle tip was a valuable aid to identify the area where the transseptal puncture must be done. In addition, the sudden changes in the P wave morphology immediately after the septal perforation, provided the first clue that the left atrium has been reached.
引用
收藏
页码:221 / 225
页数:5
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