Novel Solutions Applied in Transseptal Puncture: A Systematic Review

Abstract

Access to the left atrium is required for several minimally invasive cardiac interventions in the left heart. For this purpose, transseptal puncture (TSP) technique is often performed, perforating the atrial septum under fluoroscopic or/and ultrasound imaging guidance. Although this approach has been used for many years, complications/failures are not uncommon mainly in patients with abnormal atrial anatomy and repeated TSP. Thus, this study presents an overview of methods and techniques that have been proposed to increase the safety and feasibility of the TSP. A systematic review of literature was conducted through the analysis of the articles published between 2008 and 2015. The search was performed in PubMed, Scopus, and ISI Web of Knowledge using the expression “transseptal puncture.” A total of 354 articles were retrieved from the databases, and 64 articles were selected for this review. Moreover, these 64 articles were divided into four categories, namely: (1) incidence studies, (2) intraprocedural guidance techniques, (3) preprocedural planning methods, and (4) surgical instruments. A total of 36 articles focused on incidence studies, 24 articles suggested novel intraprocedural guidance techniques, 5 works focused on preprocedural planning strategies, and 21 works proposed surgical instruments. The novel 3D guidance techniques, radio-frequency surgical instruments, and pre-interventional planning approaches showed potential to overcome the main procedural limitations/complications, through the reduction of the intervention time, radiation, number of failures, and complications.

A competitive strategy for atrial and aortic tract segmentation based on deformable models

“…This technique was integrated into an efficient 3D segmentation framework and the advantages of the novel competitive methodology was proven for atrial body segmentation. Note that evaluation of the mid thin walls is relevant in several clinical evaluations, such as optimal inter-atrial puncture location for transseptal puncture (Morais et al, 2016) and for the evaluation of the aortic wall thickness (Malayeri et al, 2008). To the author's best knowledge, no previous work was presented for accurate segmentation of the atrial region with intact mid-thin walls, being a clear novelty of this work.…”

“…Thus, accurate assessment of the thin walls is currently not possible, missing their use for specific diagnostic purposes and interventional planning related with the thin atrial walls, e.g. transseptal puncture (Morais et al, 2016).…”

Cryoballoon ablation from above, through a prosthetic patch atrial septal defect repair

“…This organ arrangement is testament to the challenges of classification and frequent rule exceptions found in contemporary imaging series of the heterotaxy syndromes. 9 Regarding echocardiographic imaging for transseptal puncture, case series suggest improved safety with additional imaging where anatomy is challenging, 10,11 as it was in this case. Transesophageal echocardiography was chosen owing to ease of access through a standard approach and operator familiarity, and it provided invaluable additional information to fluoroscopy.…”

Development of a patient‐specific atrial phantom model for planning and training of inter‐atrial interventions

“…25,29 In this sense, the proposed phantom construction technique was able to accurately generate the straight interatrial wall, presenting a sub-optimal performance on the remaining regions. Nevertheless, the authors would like to emphasize that the majority of the inter-atrial interventions focus on the straight inter-atrial wall (e.g., transseptal puncture 26 ).…”