File:A-Proposed-Maneuver-to-Guide-Transseptal-Puncture-Using-Real-Time-Three-Dimensional-Transesophageal-174051.f1.ogv

English: Video legend: RATLe-90 Maneuver; Starting from the 2D-mid-esophageal 90 ͦ bi-caval view, activate the 3D-zoom mode. The zoom box should be optimized to include the openings of the superior vena cava (SVC), inferior vena cava (IVC) & Aortic root (Ao), with enough depth to include the whole inter-atrial septum (IAS) from both atrial perspectives excluding extra atrial tissues. Then, acquiring this volume will give us a truncated volume with the SVC pointing to the right of the screen (arrow-head), IVC pointing to the left. Then Rotate-Anticlockwise this volume for 90ͦ to have the SVC pointing superiorly (arrow-head) & the IVC pointing inferiorly. Then Tilt-Left this volume for 90ͦ to have the anatomically oriented enface view of the IAS from the right atrial (RA) perspective. Reducing the gain will remove the blood signals and allow clear identification of the SVC opening, IVC opening, Eustachian valve (EV), Coronary Sinus opening (CS) & will cause dropout artifact in the thin area of the fossa ovalis (arrow-head) that will help determining its location to guide septal puncture.