# Successful transseptal puncture through tortuous inferior vena cava with a novel transseptal guidewire: a case report

## TL;DR

A new transseptal wire successfully performed a challenging heart procedure in a patient with a twisted inferior vena cava.

## Contribution

A novel transseptal wire is proposed as a better option for severe inferior vena cava tortuosity.

## Key findings

- Conventional transseptal puncture failed due to inferior vena cava tortuosity and needle deformation.
- The novel transseptal wire completed the procedure successfully with a steerable sheath.
- The new wire is recommended over traditional needles in similar cases.

## Abstract

Atrial transseptal puncture is a fundamental manoeuvre in transseptal transcatheter interventions, and inferior vena cava tortuosity could cause failure of conventional transseptal puncture method with Brockenbrough needle.

We report a rare case of inferior vena cava tortuosity in a patient with atrial fibrillation in which the conventional transseptal puncture method failed due to marked needle deformation and was completed by a novel transseptal wire (AccuSafe™, Synaptic Medical) in combination with a steerable sheath.

Inferior vena cava tortuosity is one of the major causes of unsuccessful atrial transseptal puncture, even under the guidance of intracardiac echocardiography. The new transseptal wire should be the initial selection rather than a conventional transseptal needle when encountering severe inferior vena cava tortuosity.