Transesophageal echocardiography, Interatrial shunting, Atrial septal defect, Transseptal cannulation, Percutaneous left heart bypass support
To evaluate the hemodynamics and safety of percutaneous transseptal left heart bypass support (PLHBS), transesophageal echo (TEE) monitoring was performed on 9 patients (males, mean age=61) during PLHBS. PLHBS support was indicated for acute myocardial infarction (AMI) with cardiogenic shock in 5 patients, for circulatory support during balloon coronary angioplasty (PTCA) in 3 patients, and for dilated cardiomyopathy (DCM) in one patient. The location of the left atrial cannula was clearly observed in TEE images, and no right-to-left reversed shunt flow was observed around the cannula through the interatrial septum. In one patient, spontaneous echo and thrombus were observed in the left ventricle and the ascending aorta. Autopsies of 5 patients (mean age=60) revealed that the puncture site was properly located in the fossa ovalis in all patients, and no tearing was observed at the puncture site. The puncture was found to be completely healed in 2 patients at autopsy. Thus, TEE is an effective monitoring tool for evaluating hemodynamics and for determining the safety of the PLHBS procedure.