Figure 1. Intracardiac echocardiography-guided workflow for
achieving transseptal access.
Images obtained with the ICE probe placed in the right atrium with added
simplified graphic image in each panel for clarification. Panels A to H
show consecutive steps in achieving transseptal access. The guide wire
is marked with a red arrow in ICE images and represented with the red
line in graphic images, the tip of the dilator is marked with a purple
arrow in ICE images and represented with a purple line in graphic
images, the tip of the transseptal needle is marked with a white arrow
ICE images and represented with a black line in graphic images, the tip
of the long sheath is marked a green arrow in ICE images and represented
with a bolded green line in graphic images. VCS superior vena cava, PA
pulmonary artery, RA right atrium, LA left atrium, FO oval fossa, LSPV
left superior pulmonary vein.
A The guide wire is inserted into the VCS. B The long
sheath with the dilator inserted is advanced into the VCS over the guide
wire. C The guide wire is replaced with the transseptal needle
and the long sheath / dilator / transseptal needle assembly is withdrawn
toward the interatrial septum. D The tip of the dilator falls
on the oval fossa and its “tenting” can be seen. E The
transseptal needle is pushed through the dilator and advanced into the
LA cavity together with the tip of the dilator. F The
transseptal needle is withdrawn and the tip of the dilator remains in
the LA cavity. G The guide wire is advanced through the dilator
into the LSPV. H The long sheath and the dilator are advanced
over the guide wire into the LA cavity. The guide wire and the dilator
are withdrawn with the tip of the long sheath remaining in the LA
cavity.