Video 5.1 - Segmentation of a patient with complex anatomy prior to ablation procedure. This patient has corrected transposition in situs inversus and has undergone a "double switch" procedure (arterial switch procedure and intra-atrial Mustard baffle). The posterior right ventricle and enlarged pulmonary arteries are removed first, followed by the anterior left ventricle.
Video 5.2 - Angiographic companion to Video 5.1 showing the systemic venous pathway.
Video 5.3 - ICE in a patient with massively enlarged RA, showing irrigated catheter during ineffective ablation with catheter tip ~1 cm from endocardial surface, undetected without use of imaging.
Video 5.4 - Same patient as Video 5.3, with long vascular sheath used to advance catheter tip further to anterior RA endocardial surface. ICE now shows good tissue contact, and ablation was effective and resulted in tachycardia termination.
Video 5.5 - Patient with transposition of the great arteries who has undergone a Senning procedure, a form of intra-atrial baffling similar to the Mustard procedure described above and diagrammatically illustrated in Figure 5.7 (different patient).
Video 5.6 - Companion video to Video 5.5. In the same patient, a transseptal catheter is poised with proper trajectory to pierce the baffle and enter the pulmonary venous atrium. A small amount of angiographic contrast demonstrates that the needle is tenting the baffle material.
Video 5.7 - Demonstration of pulmonary venous atrial anatomy with an angiographic contrast injection through a transbaffle sheath. This angiogram was performed in the same patient shown in Figure 5.6.
Video 5.8 - Companion to Figures 5.9 and 5.10. This patient with an intra-atrial baffle has undergone transbaffle puncture, and a sheath is placed into the pulmonary venous atrium. A small angiographic catheter has been advanced into the supravalvar RA on the pulmonary venous side of the baffle.
Video 5.9 - Propagation sequence of periannular AT in a lateral tunnel Fontan, companion to Figures 5.6 and 5.14 (Panel A). Mapping has only been performed in the systemic venous side of the baffle but shows that the circuit must implicitly traverse the pulmonary venous portion of the atrium located between the right-sided AV groove and the margin of the intra-atrial baffle.
Video 11.1 - Apical view of right and left ventricle. The tricuspid valve leaflets are displaced inferiorly with adhesions preventing normal coaptation. The TV annulus can still be seen in its normal position. The area between the normal TV annulus and the point of TV leaflet coaptation is called the atrialized right ventricle.
Video 12.1 ICE from the RA of an aneurysmal IAS. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.2 ICE from the RA of an extremely aneurysmal septum, bowed into the right atrium across the tricuspid valve. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.3 ICE from the RA of a lipomatous septum, over 1.5 cm thick. (Image oriented so caudal is to the left, cranial is to the right) The presence of significant lipomatous hypertrophy often degrades the ability to visualize LA structures by ICE.
Video 12.4 ICE from the RV of the LV, showing a pericardial fat posterior to the LV prior to performing a transseptal puncture. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.5 ICE from the RV of the LV showing a large pericardial effusion after performing a transseptal puncture. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.6 LAO fluoroscopic video of two transseptal punctures being performed. The dilator is first withdrawn from the SVC into the RA, where it falls against the fossa. The dilator is advanced slightly to tent against the septum, and the needle is advanced across. The dilator is then advanced over the needle.
Video 12.7 LAO fluoroscopic video of a single transseptal puncture being performed, with similar steps as described in Video 12.6.
Video 12.8 RAO fluoroscopic video of a single transseptal puncture being performed, with similar steps as described in Video 12.6.
Video 12.9 ICE from the RA of the dilator tenting at the top of the fossa-too high on the septum. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.10 ICE from the RA of the dilator tenting at the bottom of the fossa-too low on the septum. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.11 ICE from the RA of the dilator tenting at a good position, oriented toward the left pulmonary veins (LPVs). The second half of the video shows color Doppler of the venous inflow from the LPVs. (Image oriented so caudal is to the left, cranial is to the right)
Video 12.12 ICE from the RA of the dilator tenting at a mid-fossa location, but oriented too anteriorly-toward the mitral valve. As the ICE probe is panned counterclockwise from the LPVs to the mitral valve, the dilator tip is seen.
Video 12.13 ICE from the RA of the dilator tenting at a mid-fossa location, but oriented too posteriorly-toward the posterior LA wall with the descending thoracic aorta seen behind it. (Image oriented so caudal is to the left, cranial is to the right)
Video 12.14 ICE from the RA of the dilator tenting toward the LPVs, while the needle is advanced across the septum. (Image oriented so caudal is to the left, cranial is to the right)
Video 12.15 ICE from the RA of saline bubbles seen in the LA when the sheath is flushed. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.16 A series of ICE clips from the RA of the dilator being withdrawn down to the mid-fossa, oriented toward the LVPs. The needle is advanced across (0:26), then the dilator is advanced over it and the septal tenting is seen to relax (0:32).
Video 12.17 ICE from the RA of the sheath being advanced over the dilator. Tenting of the septum is seen until the sheath jumps across the septum. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.18 RAO fluoroscopic video of two transseptal punctures being performed. The dilator is first withdrawn from the SVC into the RA, where it falls against the fossa. The dilator is advanced slightly to tent against the septum, and the needle is advanced across. The dilator is then advanced over the needle.
Video 12.19 A series of ICE clips from the RA of the dilator being withdrawn down to the mid-fossa, oriented toward the LVPs. The needle is advanced across (0:16), then the dilator is advanced over it (0:21), and finally the sheath across over the dilator (0:28).
Video 12.20 ICE from the RA of the steerable sheath oriented toward the mitral annulus in preparation for performing the second transseptal puncture. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.21 ICE from the RA of a second transseptal puncture. The dilator is seen tenting the septum below the first sheath, oriented toward the LVPs. Saline bubbles from the flush on the first sheath can be seen circulating in the LA.
Video 12.22 ICE from the RA of a second transseptal puncture. The dilator is tenting the fossa below the first sheath, and the needle is advanced across the septum. (Image oriented so caudal is to the left, cranial is to the right)
Video 12.23 ICE from the RA of a dilator tenting a very aneurysmal septum. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.24 LAO fluoroscopic video of the SafeSept needle being used for transseptal puncture. The needle is advanced into the LSPV, with the dilator following. The sheath tents the septum and finally jumps across following the wire into the LSPV at 0:19
Video 12.25 LAO fluoroscopic video of the SafeSept needle being used for a second transseptal puncture. The needle is advanced into the LSPV, with the dilator following. The sheath tents the septum and jumps across following the wire and pushing the dilator into the LSPV at 0:24.
Video 12.26 ICE video from the RA of a SafeSept needle being used for a second transseptal puncture in a patient with a moderately aneurysmal septum. (Image oriented so caudal is to the right, cranial is to the left)
Video 12.27 ICE video from the RA of a sheath in the LA with a mobile thrombus that has formed on the sheath. (Image oriented so caudal is to the left, cranial is to the right)