The module provides practice for left atrial access via the intra-atrial septum (fossa ovalis) using a correct and safe puncture technique, under fluoroscopic and echocardiographic guidance. During the simulation, life threatening complications such as pericardial effusion or aortic puncture will need to be attended to. The patient anatomies vary in coronary sinus, right atrium and aorta location and in fossa ovalis size, stiffness and location.

Simulated Procedural Steps and Components:
  • Identifying the fossa ovalis using one of the following techniques:
    – HIS and Coronary Sinus EP catheters positioning
    – Pigtail catheter placement
    – Ultrasound guidance using TEE (Trans Esophageal Echocardiogram) or ICE (Intracardiac Echocardiography)
  • Safe and accurate transseptal catheter positioning and orientation in the fossa ovalis
  • Tenting
  • Puncture
  • Transseptal Sheath advancement and positioning in the left atrium
  • Intra-cardiac pressure waves display to verify needle position
Echocardiography Guidance
  • A real ICE handle is used and allows to practice fluoroscopic positioning of the ICE catheter and standard view acquisition in real time.
  • A real TEE probe is used and enables practicing probe maneuvering and standard view acquisition in real time.
  • Both ICE and TEE provide realistic visualization of cardiac structures and the transseptal tools during the procedure and enable practicing anatomical recognition using labels.
  • Pre-fixed views allow to study cardiac structure ultrasound visualization in ICE/TEE standard views.
Self-guided Tutorial Case

Walks the trainee through the procedural steps of the transseptal puncture simulation using ICE Echocardiography.

Allows physicians to practice the correct and safe procedural steps independently, as if a proctor is standing next to them, including step-by-step instructional text, videos of real procedures, and colorful on-screen visual aids.