For most PTMC cases, the preferred puncture site for transseptal access to the left atrium was chosen to be the posterior, more inferior region of the fossa ovalis
. A Brocken brough needle was used for transeptal puncture, its tip identified by a tent-like deformation ("tenting") of the Interatrial septum on transesophageal echocardiography (TEE).
A radiopaque loop wire is positioned at the distal end of the steerable sheath to aid in the localization of the fossa ovalis
. The flexible puncturing needle and the steerable sheath allows pre-puncture deflection and orientation, positioning the needle in the desired puncturing location of the fossa ovalis
for transseptal access.
Most originate in the interatrial septum in the proximity of the fossa ovalis
. (3,4) Clinical presentation may vary greatly, ranging from nonspecific cardiac symptoms (dyspnea, palpitations) to generic symptoms (fever, weight loss, fatigue) or embolic events.
The latter is usually an asymptomatic continuation of the epicardial fat, and when arising from the interatrial septum, it usually spares the fossa ovalis
Once the site for TSP (fossa ovalis
) was identified (typical "jump" of the needle in LAO 50[degrees] and parallel position to the CS catheter in RAO 30[degrees]), the septum was punctured using the BRK-1 TS needle.
It commences from dorsum of foot, passes in front of medial malleolus straight up to posteromedial aspect of the knee joint, one hand breadth posterior to patella and then up to the fossa ovalis
or saphenous opening (4 cm below and lateral to pubic tubercle) where it enters the femoral vein.
Even the cannulation of the pulmonary vein can cause some problems like air embolism.2 Another technique for placement of a LA pressure monitoring line is described in which, following repair of a complex congenital heart defect, a long catheter previously advanced from the femoral vein into the right atrium is inserted across the interatrial septum through the patent foramen ovale or through a small incision in the atrial septum at the level of the fossa ovalis
. A suture is placed to close the interatrial septum around the catheter.
It revealed a huge mass hyperechogenic, heterogeneous, and lobulated attached to the fossa ovalis
part of interatrial septum.
was closed with single prolene stitch.
During right atriotomy, it was observed that there was a fossa ovalis
type 1 x 2 cm ASD and the right pulmonary veins were combined and drained into the vena cava inferior by way of a truncal vein.
The transseptal sheath/dilator was placed in the superior vena cava and then the dilator, sheath and needle combination was withdrawn inferiorly in the PA projection until the tip of the dilator "popped" into the fossa ovalis
. Positioning was always checked in the left anterior oblique projection.
In the case of our patient, a cascade of events led to the development of the groin abscess: a Richter's type hernia with part of the caecum and the appendix was created, which subsequently became strangulated; this led to perforation of the caecal wall, which allowed the enteric content to travel through the femoral ring and fossa ovalis
into the subcutaneous planes, where the abscess was established.