METHOD FOR CHOOSING THE METHOD FOR VISUALIZATION OF TRANSSEPTAL CATHETERIZATION OF THE LEFT ATRIUM Russian patent published in 2023 - IPC A61B6/02 A61B6/03 A61B8/14 A61M25/01 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology and cardiovascular surgery, and can be used to select a visualization method when performing transseptal catheterization of the left atrium (LA). Preoperative modeling is carried out according to multispiral computed tomography of the heart with contrast. Visualize the mouth of the coronary sinus. The course of the coronary sinus is determined in relation to the first branch of the left main bronchus. An ultrasound image of the interatrial septum and oval fossa is modeled in the bicaval projection and along the short axis at the level of the sinuses of Valsalva. The position of the center of the oval fossa is determined by two projections: a bicaval projection and a projection along the short axis at the level of the sinuses of Valsalva in relation to the thoracic vertebrae. The relationship of the first branching of the left main bronchus in relation to the collector of the left pulmonary veins is determined. The identified signs are evaluated in points. The mouth of the coronary sinus is not deformed, and catheterization of the coronary sinus with a diagnostic electrode is possible: yes - 4 points; no - 0 points. The axis connecting the center of the oval fossa and the center of the collector of the left pulmonary veins is parallel to the course of the coronary sinus: yes - 1 point; no - 0 points. The axis connecting the center of the oval fossa and the center of the collector of the left pulmonary veins, and the axis connecting the center of the oval fossa and the first branching of the left main bronchus lie in a plane parallel to the course of the coronary sinus: yes - 1 point; no - 0 points. The center of the fossa ovale can be visualized with simultaneous modeling of the transesophageal ultrasound image of the interatrial septum and the oval fossa in the bicaval projection and the projection along the short axis at the level of the sinuses of Valsalva: yes - 6 points; no - 4 points. If 12 points are scored, then when performing transseptal catheterization of the left atrium, fluoroscopic control is performed. If 9-11 points are scored, then when transseptal catheterization of the left atrium is performed, transesophageal echocardiographic control is performed. If less than 9 points are scored, then when performing transseptal catheterization of the left atrium, intracardiac echocardiography is performed.

EFFECT: method provides reducing the number of life-threatening complications and reducing the time of LA transseptal catheterization, allows to determine the optimal imaging technique during interventional treatment of atrial fibrillation and avoid the need to reposition the transseptal needle in the right atrium, to personalize the method for visualization of LA transseptal catheterization by assessing the complex of the most significant signs during preoperative modeling according to multispiral computed tomography of the heart with contrast.

1 cl, 5 dwg, 1 tbl, 3 ex