Left atrial and ventricular transseptal catheterization review: Losing skills?

Abstract

Transseptal catheterization has been routinely done at this institution for the past 19 years to evaluate the left heart. Reviewing the last 250 consecutive transseptal heart catheterizations between 1978 and 1986, the left atrium and ventricle were entered in all but six patients. One death occurred with four other major complications. There were 177 males and 73 females ranging from 18 to 84 years of age. Of these 250 studies, 31 were in association with direct left ventricular apical puncture; 42 were in patients with subaortic stenosis; 101 were in aortic stenosis; 26 were in patients with combined aortic and mitral disease; and four were in patients with triple prosthetic valve replacements. No attempts were made to cross the prosthetic mitral valves. A decline in the number of transseptal studies at this institution has been noted over the past 8 years and the technique is not longer taught routinely to Fellows. The reduction is due to increased emphasis on coronary artery anatomy, fewer rheumatic and prosthetic valvular admissions, and improved reevaluation by non-invasive echocardiography and doppler studies. This has resulted in a loss in proficiency among invasive cardiologists. In conclusion, the transseptal technique is potentially hazardous, but continued usage will maintain proficiency and a low major and minor complication rate.

Analysis of aortic valve gradients by transseptal technique: Implications for noninvasive evaluation

“…This complication has been noted in up to 3% of recently reported series [ 171. Our experience is similar to that of O'Keefe et al [ 181 and Schoonmaker et al [19], and may relate to confirmation of secure needle position in the left atrium before advancing the catheter across the atrial septum. Needle puncture of the aorta or atrium is unlikely to result in tamponade [ …”

Transseptal catheterization in adults: Enhanced efficacy and safety by low‐volume operators using a “non‐standard” technique

“…This technique may also be necessary for optimal evaluation of the severity of mitral valve stenosis [5,6]. Until recently transeptal catheterization was not taught in many cardiology training programs and was not widely practiced in cardiovascular centers [2]. Despite such recent technical advances as the use of the Mullins sheath [7], this lack of utilization was in part due to concerns about the morbidity and mortality of this procedure [ 1,8,9,10,11].…”

“…The advent of percutaneous mitral valvuloplasty has insured that the revival of transeptal catheterization [ 1,2,3] will be sustained. While transeptal catheterization had proven its value in the evaluation of valvular diseases, especially those involving prosthetic devices [3,4], percutaneous mitral valvuloplasty is generally dependent upon expeditious and safe transeptal catheterization.…”

Atrial septal puncture technique in percutaneous transvenous mitral commissurotomy: Mitral valvuloplasty using the inoue balloon catheter technique

“…In recent years its utility as a diagnostic tool has decreased markedly and the technique has been questioned as losing skills [3]. Since the introduction of catheter balloon percutaneous transvenous mitral cornrnissurotomy (PTMC) for treatment of mitral stenosis by Inoue et al in 1984 [4], transseptal catheterization has regained its importance, now as a vital component of this therapeutic intervention technique.…”