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Innovation in interventional cardiology

Nagare bidirectional steerable sheath

The Nagare bidirectional steerable sheath (Terumo, Japan) is a catheter that allows controlled navigation in all chambers of the heart. The sheath has bidirectional movement thanks to its TrueVector technology: the device is manufactured with a coaxial mesh in the shaft, unlike others that use pull wire systems to move the tip of the catheter. This mesh, which is Kevlar-coated, can move freely, and since it is pulled proximally along with the shaft, only the tip is deflected, with accuracy and stability. This prevents the classic whipping effect of other similar catheters in which deflection occurs along the length of the catheter rather than just the tip; this is an interesting improvement.

The Nagare bidirectional steerable sheath has an external sheath diameter of 12 Fr and an internal diameter of 8.8 Fr, with a usable catheter length of 73.7 cm. Its size allows other devices to be passed through it. It has a smooth transition to the dilator for a 0.032’’ guidewire. It can be deflected 90° or 180° on its longitudinal axis with a turning radius of 25 mm.

This device is indicated for controlled transseptal puncture. Structural interventional procedures that are performed on the left side of the heart often require a posterior puncture below the interatrial septum. A steerable sheath of this type allows better control of the puncture site.

Palabras clave: introductor deflectable, punción transeptal. Keywords: steereble sheath, transseptal puncture.