Locating the interatrial septal vein

A vein connected to the left atrium, except the pulmonary veins, is a rare anatomical variant. Most left atrium variant veins are left atrial roof veins. However, in this study, a vein was identified that was originated from the anterior aspect of left atrium and passed through the interatrial septum, named interatrial septal vein.

A 65-year-old woman with refractory paroxysmal atrial fibrillation underwent catheter ablation. Prior to the ablation, images were obtained by cardiac computed tomographic scans and transoesophageal echocardiography and showed the interatrial septal vein (Panel A and B). Three-dimensional computed tomographic scans showed that the interatrial septal vein originated from the left atrium, passed through the posterior aspect of the noncoronary cusp, across the fossa ovalis, and entered the posterior wall through the interatrial septum (Panel C). Based on the intracardiac echocardiography images, the nearest distance between the interatrial septal vein and fossa ovalis was measured to be 1.4 mm (Panel D). An atrial septal puncture was performed, avoiding injury to the interatrial septal vein, under the guidance of intracardiac echocardiography.

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In conclusion, this study demonstrated that it is important to detect the presence and location of anatomical variants using a multidetector computed tomographic scan before performing atrial fibrillation ablation. In addition, it is critical to take into account the presence and location of the interatrial septal vein to avoid severe complications such as cardiac tamponade during atrial septal puncture.

Data availability

The data underlying this article are available in the article and in its online supplementary material.

Author notes