case_images: PMC9022901_01
case_images: (A) Trans-thoracic echocardiogram revealed marked dilated right atrium and right ventricle in addition to small and compressed left atrium and left ventricle. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle. (B) Intracardiac echocardiogram (ICE) showed marked dilated right atrium and small compressed left atrium. A transseptal Brockenbrough needle and a Mullins sheath (white arrow) was probing the inter-atrial septum with a tenting sign. RA, right atrium; LA, left atrium. (C) The atrial septum was dilated with a 6 mm x 8 cm balloon (white arrow). (D) Transthoracic echocardiogram confirmed the establishment of an inter-atrial shunt from right to left (white arrow). RA, right atrium; LA, left atrium.
case_images: fcvm-09-868123-g0001.jpg
case_images: PMC9022901_01_fcvm-09-868123-g0001.jpg
case_images: F1
case_images: Trans-thoracic echocardiogram revealed a marked dilated RA and right ventricle (RV), in addition to a small and compressed left atrium (LA) and left ventricle (LV) (Figure 1A). We used a transseptal Brockenbrough needle and a Mullins sheath (Medtronic, Minneapolis, MN, USA) to probe the inter-atrial septum before entering the LA cavity under ICE guidance (Figure 1B). The atrial septum was subsequently dilated with a 5 mm x 8 cm and 6 mm x 8 cm Mustang balloon (Boston Scientific, MA, USA) (Figure 1C). Transthoracic echocardiogram confirmed the establishment of an inter-atrial shunting from right to left (Figure 1D).
case_images: (A) ICE confirmed the presence of interatrial shunting (white arrow) created by previous balloon atrial septostomy. RA, right atrium; LA, left atrium. (B) ICE showed inflation of an 8 mm balloon (white arrows) at the second session of balloon atrial septostomy. RA, right atrium; LA, left atrium. (C) ICE showed an increase of right to left shunting (white arrow) after second session of balloon atrial septostomy. RA, right atrium; LA, left atrium.
case_images: fcvm-09-868123-g0002.jpg
case_images: PMC9022901_01_fcvm-09-868123-g0002.jpg
case_images: F2
case_images: ICE confirmed the presence of an interatrial shunt created by previous BAS (Figure 2A). The second course of BAS was done with an 8 mm balloon (Figure 2B). ICE showed increased shunting from right to left after the second BAS (Figure 2C).