| AIM: To describe a simple and reliable method for locating the key anatomical structures of atrial septal puncture.Methods:(1)105 patients with left atrium CTA were collected from november 2016 to January 2017 at the Department of Cardiology,NO.1 Affiliated Hospital of Fujian Medical University,aged 42-89.Their age,gender,height,weight,body mass index(BMI),smoking history,past medical history,left atrial diameter(LAD),left ventricular diastolic diameter(LVDd),left ventricular systolic diameter(LVDs),left ventricular ejection fraction(LVEF),aortic diameter(AOD),interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT)and left ventricular mass(LVM)were recorded.The slantwise angles of atrium septum(SAAS)can be clearly displayed and measured on the left atrium CTA cross-axis map,namely,in the left atrium CTA transverse firstly found on an image crosses the level of non-coronary sinus atrial septum flat,secondly calculate the angle formed by the vertical line of the atrial septum and the sagittal plane.The mean and confidence intervals of SAAS were calculated in 105 patients.The differences of SAAS between male and female patients were compared.Pearson correlation analysis was made between SAAS and age,height,weight,BMI,LAD,LVDd,LVDs,LVEF,AOD,IVST,LVPWT and LVM.(2)A total of 99 patients with non-valvular atrial fibrillation required radiofrequency ablation were enrolled in the Department of Cardiology,First Affiliated Hospital of Fujian Medical University from October 01,2015 to December 31,2017.Their age,gender,smoking history,past medical history,LAD,LVDd,LVDs,LVEF,AOD,IVST,LVPWT and LVM were recorded.According to whether the patients were conducted left atrium CTA examination before transseptal puncture(TP),patients were divided into two groups,one is conventional group(n=73),namely the projection angle is right anterior oblique(RAO)45°,the other is improved group(n=26),namely according to the SAAS angle,and that is the projection angle.Patients in improved group weremeasured and analysised SAAS,and in the RAO the angle TP was implemented under x-ray exposure.The age,gender,smoking history,past medical history,LAD,LVDd,LVDs,LVEF,AOD,IVST,LVPWT,LVM,atrial septal puncture time and postoperative complications were compared between the two groups.Results:(1)The mean SAAS of 105 patients was 31.10°.The SAAS for males and females was respectively(31.07±2.40)°and(31.11±2.51)°,P > 0.05.No significant correlation were found between SAAS with age,height,weight,BMI,LVDd,LVDs,LVEF,AOD,IVST,LVPWT and LVM.(2)The age,history of hypertension,history of diabetes,LAD,LVDd,LVDs,LVEF,AOD,IVST,LVPWT,LVM and postoperative complications were all no significant differences among the conventional group and improved group(P>0.05).99 patients were all successfully punctured.The puncture time of the improved group is obviously shorter than that in the conventional group(5.23±1.21 vs 5.93±1.42 min,P<0.05).Pearson correlation analysis showed negative correlation between the SAAS and LAD(r =-0.715,P<0.05).Conclusion:(1)RAO(31.10±2.44)°is a suitable atrial septal projection position.SAAS is negatively correlated with the size of the left atrium,but not with the basic characteristics of the human body.Patients with larger LAD,the angle of the X-ray machine should be appropriately reduced,and the clock direction of the puncture needle should be properly biased toward the 5 to 6 o'clock direction.(2)Transseptal puncture guided by CT-derived fluoroscopy,which accurately locates the fossa ovalis and provides important information about the anatomy around it,helps determine the location of the atrial septum and the direction of the puncture needle clock to provide individualized puncture angles to the patient.Importantly,the method can shorten the time of transseptal puncture to a certain degree. |
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