18-year experience with transseptal procedures through baffles, conduits, and other intra-atrial patches

Abstract

The presence of an intra-atrial patch (IAP) has been considered a relative contraindication to transseptal puncture (TSP). The purpose of this study is to determine the efficacy and safety of the TSP through baffles, conduits, pericardial patches and other prosthetic materials in the intra-atrial septum. We reviewed the records of all pediatric patients with IAP who underwent TSP at Texas Children's Hospital from November 1979 through February 1998. The review included the cardiac diagnoses, indications for TSP, technical difficulties and follow up echocardiograms specifically addressing residual atrial shunts A total of 1958 TSP were performed. Thirty-nine patients had IAP. Cardiac diagnoses in those 39 patients included D-transposition of the great arteries after Mustard (10) or Senning procedure (6), single ventricle variant post-Fontan operation (4), total anomalous venous return repair (4), atrioventricular canal repair (9) and atrial septal defect with patch repair (6). Patients' age ranged from 1-31 years (median 7 years). The duration from the time of surgical repair to TSP ranged from 0.1-21 years (median 5 years). Indications for TSP included diagnostic and therapeutic intervention for pulmonary venous obstruction (12), creation of a baffle fenestration (2), prosthetic mitral valve evaluation (1), left ventricular outflow tract evaluation (1), access the left heart for hemodynamic evaluation (23). The IAP was traversed in 38/39 patients (97.5%), followed by diagnostic or therapeutic prograde left-heart catheterization. No complications were encountered. Follow up echocardiography in 30/38 PTS demonstrated no residual shunting across the atrial septum except for two cases in which the atrial baffle had been intentionally fenestrated. Transseptal puncture through an intra-atrial patch is a safe procedure. This technique is effective in permitting diagnostic and therapeutic left heart catheterization and does not result in residual shunting through the patch.

Transseptal puncture using surgical electrocautery in children and adults with and without complex congenital heart disease

“…TSP to undergo a left heart catheterization for various indications has been performed both in children and adults for several decades [3,8]. In the current era, TSP is considered fairly routine and has been successful with minimal complications using conventional method through Brockenbrough needle [3,9].…”

“…TSP to undergo a left heart catheterization for various indications has been performed both in children and adults for several decades [3,8]. In the current era, TSP is considered fairly routine and has been successful with minimal complications using conventional method through Brockenbrough needle [3,9]. In adults with complex septal anatomy such as septal fibrosis due to repeat procedures that are resistant to TSP using conventional needle, and in patients with aneurysmal septum (increased compliance), alternative methods using dedicated RF for TSP is fairly routine [1,10].…”

“…Echocardiogram was not performed on any patients who underwent TSP for an EP procedure. The transseptal needle was advanced through 6-8 French Mullins transseptal sheath (Medtronic, Minneapolis, MN) using standard techniques [3]. All patients received unfractionated heparin bolus after successful TSP to maintain activated clotting times between 250 and 300 sec during the procedure.…”

Retrograde aortic approach for atrial fibrillation ablation with a conventional 3‐D mapping catheter: A case report

“…2 AF ablation through a transeptal approach is safe and effective among patients who had undergone ASD patch closure. 3 However, the presence of an intra-atrial patch can create difficulty in performing a transeptal puncture, especially when a wide Gore-Tex patch is used. 4 In our case, TEE-guided transeptal puncture was attempted but we encountered resistance in traversing the atrial septum.…”

Mapping of Intraatrial Reentrant Tachycardias by Remote Magnetic Navigation in Patients with d‐Transposition of the Great Arteries After Mustard or Senning Procedure

“…Reaching the PVA turned out to be a challenge. To avoid complications of a transseptal puncture through the atrial baffle (used by some groups), 15,16 we chose the retrograde route via the aortic and tricuspid valve to access the PVA. Passing the aortic valve with the RMN catheter was especially difficult.…”