Percutaneous transseptal balloon mitral valvuloplasty: Transfemoral vs. transjugular approaches

Cheng, Tsung O.

doi:10.1002/(sici)1522-726x(200003)49:3<342::aid-ccd25>3.0.co;2-k

Cathet. Cardiovasc. Intervent.

2000

DOI: 10.1002/(sici)1522-726x(200003)49:3<342::aid-ccd25>3.0.co;2-k

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Percutaneous transseptal balloon mitral valvuloplasty: Transfemoral vs. transjugular approaches

Tsung O. Cheng

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Cited by 4 publications

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“…It is possible to reduce irradiation even further by using echocardiography, either transthoracic [8] or transesophageal [9], as a guide during transseptal catheterization. Finally, fetal irradiation can be totally avoided if the transjugular approach instead of the transfemoral approach is employed for percutaneous transseptal balloon mitral valvuloplasty [10]. However, because the cardiologists work closer to the radiation source when using the transjugular approach compared with the transfemoral technique, they receive greater radiation exposure.…”

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Percutaneous Inoue balloon valvuloplasty is the procedure of choice for symptomatic mitral stenosis in pregnant women

Cheng

2000

Cathet. Cardiovasc. Intervent.

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Percutaneous Inoue balloon valvuloplasty is the procedure of choice for symptomatic mitral stenosis in pregnant women

Cheng

2000

Cathet. Cardiovasc. Intervent.

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Transjugular percutaneous Inoue balloon mitral commissurotomy in a patient with inferior vena cava obstruction after liver transplantation

Sullebarger¹,

Coto²,

Lopez³

et al. 2003

Cathet Cardio Intervent

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All roads lead to Rome: Transjugular or transfemoral approach to percutaneous transseptal balloon mitral valvuloplasty?

Cheng

2003

Cathet Cardio Intervent

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Transseptal left atrial catheterization, which is an integral part of percutaneous transseptal Inoue balloon mitral valvuloplasty, is traditionally performed percutaneously through the femoral vein, usually the right femoral vein, because of the direct approach from the inferior vena cava to the interatrial septum at the fossa ovalis. The presence of the limbic ledge [1] further facilitates the transseptal puncture when approached from the inferior vena cava.However, there are times when the transfemoral approach might be difficult or impossible, such as in membranous obstruction of the inferior vena cava, although balloon dilation of the membranous obstruction of the inferior vena cava prior to balloon mitral valvuloplasty at the same setting could usually be successfully accomplished [2][3][4]. Also, it sometimes might be difficult for the balloon catheter to traverse the mitral valve, because the catheter introduced through the femoral vein and after trasversing the interatrial septum has to bend almost 180°to cross the mitral valve. Thus, in 1997 Joseph et al. [5] introduced the transjugular approach to transseptal balloon mitral valvuloplasty, reasoning that septal puncture by a transjugular approach could provide a more direct route to the mitral valve without the catheter having to bend over backward to cross the mitral valve. The transjugular approach is also preferred to the transfemoral approach for percutaneous balloon tricuspid valvuloplasty, because of ease of crossing the tricuspid valve and stable balloon position during dilation, especially with a dilated right atrium [6,7]. In balloon aortic valvuloplasty, tracking of the balloon catheter over a wire is easier by the transjugular approach than by the transfemoral approach, because the intracardiac course of the catheter from the mitral to the aortic valve is less convoluted than by the transfemoral approach [6,7]. Therefore, when concurrent mitral-aortic or mitral-tricuspid balloon valvuloplasty is needed, transjugular approach might be the procedure of choice [6,7].Sullebarger et al. [8] in this issue presented a case of severe mitral stenosis with severe distortion of the inferior vena cava due to prior liver transplantation, which made passage of the Brockenbrough transseptal needle through the inferior vena cava technically impossible. The transjugular approach was consequently employed and succeeded in relieving the patient's mitral stenosis.Technically speaking, the transjugular approach is more difficult to perform than the transfemoral approach, especially if the left atrium is not very enlarged [6]. Therefore, the transjugular approach may not be appropriate for isolated aortic stenosis where the left atrium is usually not enlarged. Furthermore, the conventional equipment for transseptal puncture is too long and unwieldy for the transjugular approach. Much shorter transseptal needle-and-catheter sets with increased curvature of the transseptal needle are required. Sullebarger et al.[8] cleverly employed a pediatric transseptal set. Final...

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Percutaneous transseptal balloon mitral valvuloplasty: Transfemoral vs. transjugular approaches

Cited by 4 publications

References 14 publications

Percutaneous Inoue balloon valvuloplasty is the procedure of choice for symptomatic mitral stenosis in pregnant women

Percutaneous Inoue balloon valvuloplasty is the procedure of choice for symptomatic mitral stenosis in pregnant women

Transjugular percutaneous Inoue balloon mitral commissurotomy in a patient with inferior vena cava obstruction after liver transplantation

All roads lead to Rome: Transjugular or transfemoral approach to percutaneous transseptal balloon mitral valvuloplasty?

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