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Background: Transseptal puncture (TSP) performed with the Brockenbrough (BRK) needle is technically demanding and carries potential risks. The back end of the percutaneous transluminal coronary angioplasty (PTCA) guidewire is blunt and flexible, with good support, it can puncture the right ventricle-free wall, which is thicker than the atrial-septum. The guidewire is thin and easy to manipulate. This study evaluated the performance of TSP with a PTCA guidewire and microcatheter without a needle. Methods: The back end of a PTCA guidewire was advanced into the Tiger (TIG) catheter, within the SL1 sheath, to puncture the fossa ovalis (FO) under fluoroscopy. Subsequently, the microcatheter was inserted into the left atrium (LA) above the guidewire, and the front end of the guidewire was exchanged in the LA. After the puncture site was confirmed by contrast, the TIG catheter and a 0.032 inch wire were advanced into the LA. Finally, the sheath, with the dilator, was advanced over the wire into the LA. The safety margin of this method was tested in a pig model. Results: The puncture was successful in all seven pigs tested with a puncture-to-sheath entry time of <20 minutes and no procedure-related complications. The method was successfully used to perform a difficult TSP in a patient with an extremely tortuous inferior vena cava, in whom puncture with a BRK needle had repeatedly failed. Conclusions: Cardiologists may use the PTCA guidewire and microcatheter as an alternative to the needle while performing TSP in special conditions, such as an extremely tortuous inferior vena cava. [ABSTRACT FROM AUTHOR]

Background: Application of electrocautery to a J‐wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique. Methods: Two hundred consecutive patients were randomized in a 1:1 fashion to either the ICE‐guided electrified J‐wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20 W, "coag" mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time. Results: All patients complete the procedure safely. The electrified J‐wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra‐atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the two groups (3/32 patients in the J‐wire TSP group and 2/26 patients in conventional BRK TSP group, p =.82). And no difference in the incidence of residual intra‐atrial shunt (4.3% vs. 6%, p =.654) during the 3‐month's follow up. Conclusion: Using an electrified J‐wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non‐fluoroscopy AF ablation. [ABSTRACT FROM AUTHOR]

Abstract This case report describes the 2‐dimensional transthoracic (2D‐TTE), 3‐dimensional transthoracic (3D‐TTE) and intracardiac echocardiographic (ICE) characterization of the fossa ovalis region in 2 horses. The first case was presented for poor performance and showed an anechoic zone in the interatrial septum on 2D‐TTE. Based on 3D‐TTE a deepened fossa ovalis could be identified and using ICE the presence of an interatrial shunt could be excluded. The second case was referred for a cardiac murmur and the presence of turbulent flow in and around the interatrial septum on 2D‐TTE color flow Doppler. The complementary use of 2D‐TTE, 3D‐TTE, and ICE allowed detailed characterization of a patent foramen ovale, with evidence of a left‐to‐right shunt in a dorsocranial to ventrocaudal direction with limited hemodynamic implications. These 2 cases underline the feasibility of 3D‐TTE and ICE in horses and especially show the added value of ICE in a clinical setting.

Background/Objective: Optimization of needle characteristics for trans-septal puncture is of paramount importance to reduce the extent of tissue deformation. This was achieved by studying the mechanical behavior of fossa ovalis (FO) in lamb hearts. The fossa ovalis tissue samples obtained after dissection were subjected to experimental indentation and tensile tests to determine tissue deformation. Methods: Lamb hearts (n = 20) were dissected to obtain fossa ovalis tissue samples. These were subjected to indentation and tensile tests to determine the puncture and rupture forces respectively. Indentation tests were performed using two different indenters: A steel indenter with a hemispherical tip and a Brockenbrough (BRK) needle (bevel tip). Tensile tests were formed using Zwick Roell (Z005) tensile machine at 100 N load cell. ImageJ analysis was also performed to determine the diameter and shape of FO. Results: Indentation results demonstrated that the hemispherical indenter requires a greater punch force compared to the puncture force with the BRK needle. The mean punch force of the hemispherical indenter (15.57 N) was nearly 3 times greater than the puncture force of the BRK needle (5.47 N). Variations between the two indenters provide an insight into the importance of device geometry on trans-septal procedures. The tensile test results illustrated a typical failure pattern with a toe region, linear region, and failure region. The mean rupture force determined was 10.51 N. ImageJ analysis confirmed an oval shape of FO and the diameters measured were in the range 9.0–15.3 mm. Conclusions: The mechanical aspects of fossa ovalis in lamb hearts were successfully studied through a series of experimental indentation and tensile tests. This study serves as a guide to dissecting the challenging FO sample. The procedures for indentation and tensile tests are detailed with common experimental challenges encountered addressed. The correlation of the parameters involved in these experimental tests to the collagen fiber orientation in tissues is also discussed, providing an insight into the deformation of tissues and variations in fiber orientation before and after trans-septal procedures. [ABSTRACT FROM AUTHOR]

Abstract Introduction Cryoballoon (CB) guided pulmonary vein isolation (PVI) is an established procedure in the treatment of atrial fibrillation (AF). Transseptal access is an indispensable step during PVI and may be associated with severe complications. For specific interventions, specific puncture sites of the fossa ovalis are advantageous. Here, we analyzed the potential impact of a transesophageal echocardiography (TOE) guided transseptal puncture on nadir temperatures in CB PVI. Methods and Results We retrospectively analyzed 209 patients undergoing CB PVI in our hospital. The use of TOE had been at the operator’s discretion. No TOE‐related complications such as perforation of the pharynx or esophagus or loss of teeth were noted. Concerning the applied freezes, we found significantly lower nadir temperatures in all PVs in the TOE group than in the non‐TOE group. Procedure time and fluoroscopy time and complications were similar in both groups. Conclusion TOE‐guided TSP in CB PVI is safe and feasible. Our study found significantly lower nadir temperatures of CB freezes after TOE‐guided TSP which potentially underscores the value of a more infero‐anterior puncture site.

Introduction: Left‐sided accessory pathway (AP) with atrial insertion away from the annulus is an atypical variation. Conventional mapping and ablation performed along mitral annulus (MA) is usually ineffective.Methods: A 14‐year‐old girl without structural heart disease presented with recurrent episodes of sudden onset palpitations and electrocardiogram (ECG) showed a narrow QRS complex tachycardia.Results: Electrophysiology study (EPS) was done and anterograde atrioventricular reentrant tachycardia (AVRT) with AP was diagnosed. Conventional mapping and ablation performed along TA and MA was failed. 3D‐activation mapping found the retrograde atrial insertion site of AP on the left atrium fossa ovalis (FO), and AP was successfully abolished by radiofrequency ablation at that site.Conclusion: As reported, this patient is the first report of ablating a left‐sided AP with retrograde atrial insertion on the left atrium FO. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosures The authors have no conflicts of interest to disclose.

This case report describes the 2‐dimensional transthoracic (2D‐TTE), 3‐dimensional transthoracic (3D‐TTE) and intracardiac echocardiographic (ICE) characterization of the fossa ovalis region in 2 horses. The first case was presented for poor performance and showed an anechoic zone in the interatrial septum on 2D‐TTE. Based on 3D‐TTE a deepened fossa ovalis could be identified and using ICE the presence of an interatrial shunt could be excluded. The second case was referred for a cardiac murmur and the presence of turbulent flow in and around the interatrial septum on 2D‐TTE color flow Doppler. The complementary use of 2D‐TTE, 3D‐TTE, and ICE allowed detailed characterization of a patent foramen ovale, with evidence of a left‐to‐right shunt in a dorsocranial to ventrocaudal direction with limited hemodynamic implications. These 2 cases underline the feasibility of 3D‐TTE and ICE in horses and especially show the added value of ICE in a clinical setting. [ABSTRACT FROM AUTHOR]

Objective: The development of new trans septal transcatheter interventions for patients with structural heart disease necessitates a precise and comprehensive understanding of anatomy of interatrial septum. The scarce gross anatomical studies have triggered our interest to explore the morphometry and morphology of interatrial septum. Methods: The study was conducted in the Department of Anatomy and Department of Forensic medicine & Toxicology of King George's Medical University, Lucknow, India, on 100 autopsied human hearts, in which we observed the position and shape of fossa ovalis (FO) along with location of prominence of limbus. The diameter of FO and thickness of its floor was measured and redundancy or any variation in interatrial septum was noted. Results: In most of the cases (72.9%) FO was situated towards the inferior vena cava and was oval shaped (69.8%), with mean horizontal and vertical diameter of 17.21±4.11 mm and 12.74±3.78 mm respectively. Limbus was prominent in 72.2% specimens, commonly prominent all around (36.6%) followed by antero-superior (28.2%), antero-inferior (16.9%) and anterior (8.5%) prominence. Mean thickness of floor of FO was 0.71±0.98 mm, showed redundancy in 47% samples. Probe patency was seen only in 10.3% specimens. The right surface of interatrial septum showed more variations (71.1%) as compared to left (44.3%), in form of recess, atrial septal pouch, fibrous strand, retinacular type of fibrous network or combination of more than one type. Conclusion: Variations in location of FO, prominence of limbus and common occurrence of anatomical variants of interatrial septum mandates the pre-procedural/procedural imaging of the region to reduce the failure rates and complications. [ABSTRACT FROM AUTHOR]

Introduction: Cryoballoon (CB) guided pulmonary vein isolation (PVI) is an established procedure in the treatment of atrial fibrillation (AF). Transseptal access is an indispensable step during PVI and may be associated with severe complications. For specific interventions, specific puncture sites of the fossa ovalis are advantageous. Here, we analyzed the potential impact of a transesophageal echocardiography (TOE) guided transseptal puncture on nadir temperatures in CB PVI. Methods and Results: We retrospectively analyzed 209 patients undergoing CB PVI in our hospital. The use of TOE had been at the operator's discretion. No TOE‐related complications such as perforation of the pharynx or esophagus or loss of teeth were noted. Concerning the applied freezes, we found significantly lower nadir temperatures in all PVs in the TOE group than in the non‐TOE group. Procedure time and fluoroscopy time and complications were similar in both groups. Conclusion: TOE‐guided TSP in CB PVI is safe and feasible. Our study found significantly lower nadir temperatures of CB freezes after TOE‐guided TSP which potentially underscores the value of a more infero‐anterior puncture site. [ABSTRACT FROM AUTHOR]

Background: The anatomical characterization of foramen ovale (FO) along with annulus or limbus varies in size and shape from the heart to heart. Patent FO (PFO) has been implicated in the etiology of a number of diseases, PFO is not an uncommon condition; their prevalence rate is 15%–35% in the population. Hence, morphological study of FO serves importance to know the exact location of the fossa ovalis (FOv) and prevalence of PFO in the Indian population by the autopsy method. Materials and Methods: This study was conducted in 106 apparently normal hearts available in the Department of Anatomy and Forensic Medicine and Toxicology. After opening the right atrium, the shape of FOv was observed, and dimensions were measured with the digital Vernier caliper and thickness of anterior and posterior limbus was noted. Probe patency was confirmed. Results: Area of the FOv (160.20 ± 104.9 mm2), thickness anterior limbus (7.24 ± 1.83 mm), and thickness of posterior limbus (6.38 ± 2.46 mm). The shape of FOv was oval (83%) in majority; in 86.7%, the rim of the limbus was raised and 13.3% it was flat; in 20.75%, a recess was found deep to the margin of the limbus and 10.37% showed probe patency. A significant positive correlation was observed between cardiac weight and area of FOv. Conclusion: By autopsy method, we found the prevalence of PFO is 4.71%, which is lower than Western population, our study also provides the accurate measurements related with several morphometric variation such as shape of FOv and limbus FOv.

Introduction: Transseptal puncture (TSP) is widely used in clinical practice but is negatively affected by a nonneglectable rate of complications and X‐ray exposure. To address these problems, we investigated whether or not impedance mapping could correctly identify fossa ovalis (FO) and safely guide TSP. Methods and Results: Electroanatomic mapping was performed with CARTO 3 system version 7 and a ThermoCool® SmartTouch® mapping catheter was employed. In each patient, an impedance map and a bipolar voltage map of the whole interatrial septum were collected, acquiring at least 150 points with a contact force ≥2 g and using the pattern matching filter. Thirty‐five patients were enrolled. A low impedance area was clearly identified in 34 of them. In 30 patients (88%), the FO was located in the low impedance area. The map was obtained in sinus rhythm in 17 cases (50%); in 15 of these (88%), the TSP site, the patent foramen ovale, or the FO tenting area fell inside the low impedance area. The same numbers were observed when mapping during atrial fibrillation. Conclusion: To the best of our knowledge, this is the first study that provides the reliability and reproducibility of impedance mapping in identifying FO, an affordable and feasible tool that could be potentially introduced into clinical practice. [ABSTRACT FROM AUTHOR]

Background/Objective: Optimization of needle characteristics for trans-septal puncture is of paramount importance to reduce the extent of tissue deformation. This was achieved by studying the mechanical behavior of fossa ovalis (FO) in lamb hearts. The fossa ovalis tissue samples obtained after dissection were subjected to experimental indentation and tensile tests to determine tissue deformation. Methods: Lamb hearts (n = 20) were dissected to obtain fossa ovalis tissue samples. These were subjected to indentation and tensile tests to determine the puncture and rupture forces respectively. Indentation tests were performed using two different indenters: A steel indenter with a hemispherical tip and a Brockenbrough (BRK) needle (bevel tip). Tensile tests were formed using Zwick Roell (Z005) tensile machine at 100 N load cell. ImageJ analysis was also performed to determine the diameter and shape of FO. Results: Indentation results demonstrated that the hemispherical indenter requires a greater punch force compared to the puncture force with the BRK needle. The mean punch force of the hemispherical indenter (15.57 N) was nearly 3 times greater than the puncture force of the BRK needle (5.47 N). Variations between the two indenters provide an insight into the importance of device geometry on trans-septal procedures. The tensile test results illustrated a typical failure pattern with a toe region, linear region, and failure region. The mean rupture force determined was 10.51 N. ImageJ analysis confirmed an oval shape of FO and the diameters measured were in the range 9.0–15.3 mm. Conclusions: The mechanical aspects of fossa ovalis in lamb hearts were successfully studied through a series of experimental indentation and tensile tests. This study serves as a guide to dissecting the challenging FO sample. The procedures for indentation and tensile tests are detailed with common experimental challenges encountered addressed. The correlation of the parameters involved in these experimental tests to the collagen fiber orientation in tissues is also discussed, providing an insight into the deformation of tissues and variations in fiber orientation before and after trans-septal procedures.

Background and Objectives: Our study aimed to investigate the gross anatomy aspects of the fossa ovalis (FO) and the presence of some anatomical variation resulting from the incomplete fusion of septum primum and septum secundum, such as an atrial septal pouch (SP) and left atrial septal ridge. Materials and Methods: Thirty-one adult human hearts removed from formalin-fixed specimens were examined to provide information about the morphology of the FO. The organs were free of any gross anatomically visible pathological conditions. Results: The most common variants were the FO located in the inferior part of the interatrial septum (64.51%), circular (61.3%), with a net-like structure (51.62%), prominent limbus (93.55%), and patent foramen ovale (PFO) (25.8%). The right SP was observed in 9.67% of specimens, the left SP was observed in 29.03% of cases, and in 51.61% of cases, a double SP was observed. One sample presented a right SP and a double left SP, and one case showed a triple left SP, which was not reported previously to our knowledge. Conclusions: Knowledge of the interatrial septal anatomy becomes important for interventional cardiologists and should be documented before transeptal puncture. [ABSTRACT FROM AUTHOR]

Background: The anatomical characterization of foramen ovale (FO) along with annulus or limbus varies in size and shape from the heart to heart. Patent FO (PFO) has been implicated in the etiology of a number of diseases, PFO is not an uncommon condition; their prevalence rate is 15%-35% in the population. Hence, morphological study of FO serves importance to know the exact location of the fossa ovalis (FOv) and prevalence of PFO in the Indian population by the autopsy method. Materials and Methods: This study was conducted in 106 apparently normal hearts available in the Department of Anatomy and Forensic Medicine and Toxicology. After opening the right atrium, the shape of FOv was observed, and dimensions were measured with the digital Vernier caliper and thickness of anterior and posterior limbus was noted. Probe patency was confirmed. Results: Area of the FOv (160.20 ± 104.9 mm2), thickness anterior limbus (7.24 ± 1.83 mm), and thickness of posterior limbus (6.38 ± 2.46 mm). The shape of FOv was oval (83%) in majority; in 86.7%, the rim of the limbus was raised and 13.3% it was flat; in 20.75%, a recess was found deep to the margin of the limbus and 10.37% showed probe patency. A significant positive correlation was observed between cardiac weight and area of FOv. Conclusion: By autopsy method, we found the prevalence of PFO is 4.71%, which is lower than Western population, our study also provides the accurate measurements related with several morphometric variation such as shape of FOv and limbus FOv. [ABSTRACT FROM AUTHOR]

Aim. To analyze the preoperative status, intraoperative tumor characteristics and further clinical manifestations in patients after surgery for a cardiac tumor.Material and methods. The study included 54 patients who were operated on for a heart tumor from 2014 to 2020. We assessed clinical performance, diagnostic investigations before and after (during hospitalization) surgery, tumor size and histological characteristics.Results. Among patients operated on for cardiac tumors, women predominated (74%). Among comorbidities, hypertension (79,3%), chronic kidney disease (48,3%), and obesity (25,9%) were most common. There were following clinical manifestations before surgery: shortness of breath — 47 (81%) patients, palpitations and heart rhythm disturbance — 26 (44,8%), chest pain — 25 (43,1%), chest discomfort — 28 (49,1%), edema — 6 patients (10,3%). The predominant tumor localization was the left atrial fossa ovalis area (50%). According to histological analysis, myxoma prevailed — 38 cases (86,4%). After surgery, atrial fibrillation prevalence decreased from 8 patients before surgery to 6 after surgery (p=0,034), while left atrial size decreased by 0,6 mm (95% confidence interval, 4,39-6,2 mm) (p

Background: Transseptal puncture (TSP) performed with the Brockenbrough (BRK) needle is technically demanding and carries potential risks. The back end of the percutaneous transluminal coronary angioplasty (PTCA) guidewire is blunt and flexible, with good support, it can puncture the right ventricle-free wall, which is thicker than the atrial-septum. The guidewire is thin and easy to manipulate. This study evaluated the performance of TSP with a PTCA guidewire and microcatheter without a needle., Methods: The back end of a PTCA guidewire was advanced into the Tiger (TIG) catheter, within the SL1 sheath, to puncture the fossa ovalis (FO) under fluoroscopy. Subsequently, the microcatheter was inserted into the left atrium (LA) above the guidewire, and the front end of the guidewire was exchanged in the LA. After the puncture site was confirmed by contrast, the TIG catheter and a 0.032 inch wire were advanced into the LA. Finally, the sheath, with the dilator, was advanced over the wire into the LA. The safety margin of this method was tested in a pig model., Results: The puncture was successful in all seven pigs tested with a puncture-to-sheath entry time of < 20 minutes and no procedure-related complications. The method was successfully used to perform a difficult TSP in a patient with an extremely tortuous inferior vena cava, in whom puncture with a BRK needle had repeatedly failed., Conclusions: Cardiologists may use the PTCA guidewire and microcatheter as an alternative to the needle while performing TSP in special conditions, such as an extremely tortuous inferior vena cava., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 The Author(s). Published by IMR Press.)

Background: The foramen ovale, present in foetal interatrial septum, plays an important role during foetal life. During delivery, foramen ovale closes and becomes fossa ovalis, starting the pulmonary circulation. The aim of our study was to describe the growth of the interatrial wall and changes in location of the foramen ovale, and fossa ovalis during the ontogenesis in the human hearts.Materials and Methods: The study was performed on post-mortem material obtained from 92 human hearts from 22nd week of foetal life up to 1 year of age, fixed in a 4% formalin solution.Results: The interatrial wall size in the studied development period was greater in the horizontal than in the vertical dimension. During ontogenesis up to 1 year old, the anterior and inferior parts of the interatrial wall increased their shares considerably by 8% and 6%, respectively. The percentage participation of foramen ovale in the interatrial wall construction in the foetal period formed more than 50% of its size and fairly decreased reaching in infants about 39%.Conclusions: Our study demonstrated that during ontogenesis, from the foetal period to infancy, the parts of the interatrial wall increase their dimensions unevenly. The foramen ovale growth is smaller, compared to the rest of the interatrial wall development. On the basis of our data we can assume that the foramen ovale centre tends to be found in the postero-inferior quadrant of the interatrial wall (foetuses) and in postero-superior quadrant of the interatrial wall - in infants. [ABSTRACT FROM AUTHOR]

Aims: Transseptal puncture (TP) for left atrial (LA) catheter ablation procedures is routinely performed under fluoroscopic guidance. To decrease radiation exposure and increase safety alternative techniques are desirable. The aim of this study was to assess whether right atrial (RA) electroanatomic 3D mapping can reliably identify the fossa ovalis (FO) in preparation of TP.Methods and Results: Between May 2019 and August 2019, electroanatomic RA mapping was performed before TP in 61 patients with paroxysmal or persistent atrial fibrillation. Three electroanatomic methods for FO identification, mapping catheter-induced FO protrusion, electroanatomic-guided analysis, and voltage mapping, were evaluated and compared with transoesophageal echocardiography (TOE). Mapping catheter-induced FO protrusion was feasible in 60 patients (98%) with a mean displacement of 6.8 ± 2.5 mm, confirmed by TOE, and proofed to be the most valuable and easiest marker for FO identification. Electroanatomic-guided analysis localized the FO midpoint consistently in the lower half (43 ± 7%) and posterior (18.2 ± 4.4 mm) to a line between coronary sinus and vena cava superior. Analysis of RA voltage maps during sinus rhythm (n = 40, low-voltage cut-off value 1.0 and 1.5 mV) allowed secure FO recognition in 33% and 18%, only. A step-by-step approach, combining FO protrusion (first step) with anatomy criteria in case of protrusion failure (second step) would have allowed for the correct localization of a TP site within the FO in all patients.Conclusion: Right atrial electroanatomic 3D mapping prior to TP proofed to be a simple tool for FO identification and may potentially be of use in the safe and radiation-free performance of TP prior to LA ablation procedures. [ABSTRACT FROM AUTHOR]

Background and Objectives: Our study aimed to investigate the gross anatomy aspects of the fossa ovalis (FO) and the presence of some anatomical variation resulting from the incomplete fusion of septum primum and septum secundum, such as an atrial septal pouch (SP) and left atrial septal ridge. Materials and Methods: Thirty-one adult human hearts removed from formalin-fixed specimens were examined to provide information about the morphology of the FO. The organs were free of any gross anatomically visible pathological conditions. Results: The most common variants were the FO located in the inferior part of the interatrial septum (64.51%), circular (61.3%), with a net-like structure (51.62%), prominent limbus (93.55%), and patent foramen ovale (PFO) (25.8%). The right SP was observed in 9.67% of specimens, the left SP was observed in 29.03% of cases, and in 51.61% of cases, a double SP was observed. One sample presented a right SP and a double left SP, and one case showed a triple left SP, which was not reported previously to our knowledge. Conclusions: Knowledge of the interatrial septal anatomy becomes important for interventional cardiologists and should be documented before transeptal puncture.

Purpose of Review: Transseptal puncture is a routinely performed interventional cardiology procedure for an array of cardiac diseases. We aimed to review the current status of available devices and techniques of transseptal puncture with consideration to specific interventions. Recent Findings: Except for a few modifications, devices for transseptal puncture technique has not changed much compared to when it was first described almost 60 years ago. For difficult transseptal puncture, a few newer techniques such as radio frequency needle puncture system have been used but there is lack of robust clinical study. Advanced imaging, such as intracardiac echocardiography and transesophageal echocardiography, has been found to make transseptal puncture safer. A new transseptal approach that incorporates 3D non-fluoroscopic catheter tracking systems has shown promising results in two human studies. Summary: While various modifications in the transseptal technique tailored to the specific interventions have improved procedural safety, further improvement in existing devices focusing on distinct procedure might be needed in the future. [ABSTRACT FROM AUTHOR]

Aims: Patent foramen ovale (PFO) has been implicated in the etiology of a number of different pathologies, including cryptogenic stroke, decompression sickness in divers, etc. It can act as a channel for paradoxical embolism. PFO is not an uncommon condition, with a probe-patency in 15–35% population. The fossa ovalis (FOv) varies in size and shape from heart to heart; the prominence of annulus FOv also varies. The entire FOv may be redundant and aneurysmal. The anatomico-functional characterization of interatrial septum seems to be of paramount importance for both atrial septal defect (ASD) and PFO, not only for the device selection, but also for the evaluation of the outcome of this procedure. Method: This study was conducted in 50 apparently normal hearts available in Department of Anatomy. After opening the right atrium, the shape of FOv was observed. The size was measured with the digital vernier caliper; the prominence and extent of limbus, and the redundancy or otherwise of FOv were noted; probe patency was confirmed. Results: In the majority, FOv was oval (82%); average transverse diameter was 14.53 mm and vertical 12.60 mm. In 90%, the rim of the annulus was raised; in 20%, a recess was found deep to the margin of the annulus; and 18% showed probe patency. Conclusion: As no study of this nature has been carried out in the Indian population, this provides pertinent information on the morphology of FOv, which may be useful for device selection in treating ASD and PFO.

The development of new transseptal transcatheter interventions for patients with structural heart disease is fueling increasing interest in transseptal puncture techniques. The authors review contemporary transseptal puncture indications and techniques and provide a step-by-step approach to challenging transseptal access and procedural complications. [ABSTRACT FROM AUTHOR]