Puncture of atrial septal via superior vena cava access in minipigs

Abstract

Objective To evaluate the feasibility of new technique for puncture of the interatrial septum via superior vena cava. Methods The puncture needle and catheter was modified firstly.Twelve minipigs were assigned into this test, 6 minipigs in femoral group (interatrial septum was punctured according to Ross method)and another 6 minipigs in jugular group (interatrial septum was punctured via jugular vein access). The diameter of interatrial septum puncture, left ventricular ejection fraction (LVEF)of pre-operation and after-operation were recorded by echocardiography. The operation, radiation time and complication was recorded. After dissection, the location of exact puncture defect was observed. Results With the help of recreated puncture catheter and guide wire, puncture of interatrial septum via superior vena cava was achieved successfully. Echocardiography confirmed that the diameters of interatrial septum puncture in femoral and jugular groups were (2.4±1.1) mm vs. (2.3±0.9) mm (P>0.05), no statistically significant. In jugular groups (n=5), LVEF before and after surgery were 0.64±0.05 vs. 0.63±0.03 (P>0.05), no statistically significant. And in femoral group (n=5), LVEF before and after surgery was 0.62±0.05 vs. 0.63±0.04, no statistically significant. There was no either malignant arrhythmia, cardiac rupture in the surgery of both groups. There was one cardiac tamponade case in jugular group. With the surgery practiced more, the overall surgery and radiation time decreased. Actually, the surgery and radiation time in jugular group was less than that in femoral group. After dissection, we found out that puncture defect of 3 cases in jugular group was in fossae ovalis, and the puncture defect in another 2 cases located in the lower part of the fossa ovalis in atrial septal. Likewise, in femoral group, there were only one case in fossa ovalis and another 4 were in the lower part of the fossa ovalis in atrial septal. Conclusion It is feasible and safe to puncture atrial septal through superior vena cava. Key words: Cardiac resynchronization therapy; Superior vena cava access; Transseptal; Safety; Feasibility