Using left atrial esophagus impression after a barium swallow to determine the optimal septal puncture site during percutaneous balloon mitral valvuloplasty

BACKGROUND: Transseptal catheterization is the key to a successful percutaneous balloon mitral valvuloplasty (PBMV). The primary aim of the study was to investigate new methods of transseptal catheterization for PBMV. METHODS: Eighty-four patients with rheumatic mitral stenosis were randomized into two groups for PBMV. In the study group, the left atrial (LA) impression on the esophagus after a barium swallow was used as a reference of LA silhouette to determine the septal puncture site. In the control group, the LA silhouette under a normal fluoroscopic view was used for the determination of septal puncture site. RESULTS: In the study group, the average length of esophagus impression after a barium swallow was similar to the size of the left atrium measured by angiography (43.8±0.6 mm versus 44.1±0.7 mm, n=42, P>0.05). The success rate of atrial septum puncture in the study and control groups were 100% and 64.3%, respectively (P<0.01). Transseptal catheterization was subsequently achieved using the barium swallow approach in the 15 initially unsuccessful patients from the control group. PBMV was successful in the 84 patients with significant reduction in LA pressure and improvement of clinical symptoms. CONCLUSIONS: Transseptal catheterization in patients undergoing PBMV can be safely and effectively performed using the barium swallow approach.