A Proposed Maneuver to Guide Transseptal Puncture Using Real-Time Three-Dimensional Transesophageal Echocardiography: Pilot Study

Figure 1

RATLe-90 Maneuver; starting by 2D-mid-esophageal 90° bicaval view (a), activate the 3D-zoom mode. The zoom box should be optimized to include the openings of the superior vena cava (SVC), inferior vena cava (IVC), and aortic root (Ao), with enough depth to include the whole interatrial septum (IAS) from both atrial perspectives excluding extra atrial tissues (b). Then, acquiring this volume will give us a truncated volume with the SVC (arrow head) pointing to the right of the screen, IVC pointing to the left, left atrial perspective of the IAS is up, and right atrial perspective is down (c). Then we will rotate anticlockwise this volume for 90° around the -axis to have the SVC pointing superiorly (arrow head) and the IVC pointing inferiorly (d). Then we will Tilt-Left this volume for 90° around the -axis to have the anatomically oriented en face view of the IAS from the right atrial (RA) perspective (e).