Difficult case of a trans-septal puncture: Use of a “SafeSept” guidewire

Figure 1 Intracardiac echo imaging. Correct localization of the puncture site with tenting of the fossa ovalis without crossing the interatrial septum.

Figure 2 “SafeSept” trans-septal guide wire. Details of the radiopaque coil and the rounded J shape of the tip.

Figure 3 Sequence of fluoroscopy imaging of trans-septal puncture in the same projection (left anterior oblique view). A: The esotherm sound for the esophageal temperature control and coronary sinus catheter are in place. The “SafeSept” guidewire penetrates the fossa ovalis; B: The “SafeSept” guidewire is visible in the left atrium thanks to radiopaque coil; C: The trans-septal assembly (needle, dilator and sheath) is placed in the right atrium before crossing the fossa ovalis; D: The distal part of trans-septal guidewire is positioned in the left superior pulmonary vein.

Figure 4 Sequence of intracardiac echo imaging of trans-septal puncture. The “SafeSept” guidewire is advanced through the trans-septal needle; while tenting constant force on the septum (A-C), the “SafeSept” easily crosses the fossa ovalis (D-F).