METHOD OF TRANSSEPTAL PUNCTURE IN CRYOBALLOON ABLATION OF PULMONARY VEIN MOUTHS Russian patent published in 2020 - IPC A61B1/00 

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, specifically to cardiology. According to the first version, an introducer is installed for transseptal puncture SR0 in the upper hollow vein, an echocardiographic sensor is installed in the heart for interatrial septum (IAS) imaging. Introducer is used for transseptal puncture with transseptal needle from superior vena cava in right atrium (RA) under fluoscopic control. Introducer is installed in area of oval fossa IAS. At that, the transseptal needle tip is installed in the central-rear position in the IAS, which is controlled by the intracardiac EchoCG. IAS is visualized by setting the sensor for the ICEchoCG control. Central position of the transseptal needle in the IAS is confirmed by the equal distance of the needle tip from the muscle crus of IAS and the fibrous ring of the tricuspid valve. Posterior position is confirmed as follows: rotation of intracardiac sensor by 40–90° clockwise allows visualizing aortic root, and counterclockwise by 30–80° is a posterior wall of the left atrium (LA). Turn angle of clockwise rotation for visualization of aortic root by 10–20 % was more than turning angle counterclockwise for visualization of rear wall LA. According to the second version of the method, an introducer for transseptal puncture SR0 is inserted into an upper vena cava. Echocardiographic sensor is inserted into the esophagus. Introducer is provided for transseptal puncture with a transseptal needle from the superior vena cava into the right atrium (RA) under fluoscopic control. Introducer is installed in area of oval fossa IAS. At that, the transseptal needle tip is installed in the central-rear position in the IAS, which is controlled under TEEchoCG. Thereafter, the position data are determined by internal reference points – a flap ring of the aortic valve. IAS is sequentially visualized in two oesophageal positions: a short aortic valve and a bivalve valve. This position is visualized in the upper oesophageal position of the sensor, by 45–75 and enables assessing the front-rear position of the transseptal needle, wherein the aortic valve is located in the center, the IAS separating RA and LA is located 10 hours from the valve. Bicaval position is achieved by positioning the sensor in the middle one-third of the esophagus, after removing the short axis of the aortic valve, clockwise rotation of the sensor and angulation change of 90–120°, so that cavity RA, cavity LA and separating IAS are visualized in the center. Bicaval position allows assessing upper, central and lower positions of transseptal introducer and needle.

EFFECT: group of inventions makes it possible to simplify achievement of PV with cryoballon irrespective of variability of anatomy of PV that promotes reduction of time of procedure and increases efficiency PSA that reduces necessity of repeated procedures, frequency of hospitalizations and improves quality of life of patients.

2 cl, 8 dwg, 2 ex