Preventing complicated transseptal puncture with intracardiac echocardiography: case report

Additional File 1:

Preprocedural transesophageal echocardiography. The irregular oval-shaped structure at the center of the screen is the aortic root. At a certain moment one can see at its upper part the ostium and the most proximal part of the right coronary artery. Below is situated the left atrium and to the left – the right atrium. The oval fossa is in between.

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Additional File 2:

Intracardiac echocardiography, showing distorted intracardiac anatomy. The oval shape in the center of the screen is the non-coronary sinus of Valsalva. Below is the right atrium at the bottom of which the transseptal needle is clearly visible. The prominent muscular structure in the left-hand part of the image is the terminal crest. The membrane of the oval fossa, adjacent to the right-hand part of the non-coronary aortic sinus shows bidirectional flapping motion. During the atrial contraction the cavity of the left atrium virtually disappears.

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Additional File 3:

Intracardiac echocardiography showing sliding of the needle towards the aorta. The transseptal needle is already in the oval fossa with its tip pointing to the aorta. This is especially clearly visible after a premature beat.

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