The Limbic Ledge

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Abstract
A technique modifying the standard Brockenbrough method of crossing the atrial septum by positively identifying an anatomical landmark in the right atrium is described in a series of 145 patients. The catheter tip is placed in apposition to the atrial septum and drawn down the septal wall. As the tip clears the upper rim of the fossa ovalis (the limbic ledge) there is a precise, finely demarcated movement to the left, and the catheter comes to lie immediately below the ledge on the "paper-thin" area of the fossa floor. Perforation of the septum at this point has been achieved in 63% of cases without needle puncture, and in all cases with greater speed and safety, and less complication. In aortic valve disease, the ledge is encountered higher, and in mitral disease lower than the previously recommended puncture site.