Difficult case of a trans-septal puncture: Use of a “SafeSept” guidewire

A 69-year-old man was admitted to our center to undergo catheter ablation of paroxysmal atrial fibrillation refractory to antiarrhythmic drug therapy. This procedure required access to the left atrium through the interatrial septum. During hospitalization, the patient performed routinely pre-procedure transthoracic echocardiography and gadolinium-enhanced cardiac magnetic resonance showing a normal anatomy of both the fossa ovalis and the interatrial septum. Access to the left atrium proved difficult and several unsuccessful attempts to perform the trans-septal puncture were made under both fluoroscopy and intracardiac echocardiography guidance, even with radiofrequency energy delivery. Finally, trans-septal puncture was successfully carried out using a novel nitinol J-shaped "Safe Sept" trans-septal guidewire, designed to cross the interatrial septum through the trans-septal needle thanks to a special sharp tip. Moreover, thanks to its rounded J shape that reduces the risk of atrial perforation, the "Safe Sept" guidewire, when advanced into the left atrium, becomes atraumatic.

Cardiac Myxoma: 10 Years Study of Presentations, Resection and Outcome

Background: Cardiac myxoma is a very rare heart tumor which presents as life threatening mass in cardiac chamber. The tumor may present with vague symptoms which can lead to delay in diagnosis. Methods: 22 patients underwent complete excision of intracardiac myxoma between January 2011 and December 2020. Majority of the patients were females (60%) with mean age of 48.9 years who presented with symptoms of dyspnea on exertion. 3 patients had significant complications due to myxoma. 2 presenting with tumor embolism and limb ischemia while 1 patient presented with pulmonary edema. All patients were diagnosed by echocardiography which helped in evaluation of size and extent of tumor. Majority of patients underwent trans-septal biatrial approach for tumor excision. Results: 95% of patients survived the operation. The mean tumor size excised was 5.0 ± 1.6 cm in the largest diameter. 11 patients had sessile tumor while 1 patient had dumb bell tumor occupying both atria. 15 patients were surviving the operation while 2 deaths happened after 6 years of surgery. Conclusion: Cardiac myxomas are rare tumors which can cause severe systemic and cardiac symptoms in patients. Early diagnosis and immediate surgical management give excellent early and long-term results.