Septal Flush/Stain Method (Lateral View)		  

        In the lateral projection, locating an appropriate puncture site is less precise as the landmarks in this view depend very much on the left and right atrial sizes. However, the lateral view serves to confirm the appropriate posterior direction of the needle/catheter assembly and enables the atrial septal outline and orientation to be determined either by right atrial angiography or by the septal flush/stain method described below.
1) Septal flush

       This method involves continuous flushing of
the posteromedially-directed needle with contrast medium as it is withdrawn caudally. This maneuver will outline the right atrial margin of the septum
and its orientation (Figure, right panel) and a high
septal puncture can thus be avoided. Puncture at
a high site results in atrial septal dissection, and
at a low site in right atrial puncture.
Septal Flush
K838 PSH

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2) Septal stain

       Staining of the atrial septum with contrast medium is used when there is no blood aspirated after septal puncture is made. In this case the needle has either dissected the high septum or is caught in the thickened septum. When the high septum is dissected, it appears stained in more vertical fashion (Figure A).

       In this situation the catheter/needle should be withdrawn and septal puncture made at a lower
site (Figure B). If there is a marked septal
resistance and septal puncture cannot be made,
the puncture is made at a different location
(Figure C, lateral panel, open arrow).

       Usually the transseptal puncture site is in the inferior and posterior fossa ovalis. In cases wherein the puncture is made more caudally, it is made in the muscular septum. When the needle is caught
in the thickened muscular septum, the stain takes on a more horizontal direction. When the catheter/needle is advanced, a "tenting" of the septum is observed before the septum is entirely pierced by the catheter/needle (Figure C, lateral panel, thick arrow).


Septal Stain
Frontal                              Lateral


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         The figure on the right illustrates a combined flush (Figure A) and stain (Figures B and C)
method in a case of giant atrium.

       A high puncture results in a vertical stain (Figure B) as the needle direction is parallel to that of the septum. The puncture is made at a more caudal site (Figure C).

       Staining of the septum with a small amount
of contrast medium is of no consequence since
the contrast medium is absorbed rapidly.
Septal Flush/Stain

Lateral Views

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Questions or Comments? Email shung@pipeline.com.