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

Doorey, Andrew J.; Goldenberg, Edward

doi:10.1002/ccd.1810220402

Cited by 11 publications

(1 citation statement)

References 14 publications

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“…5). Die Mortalität betrug bis zu 0,6 % (1,3,4,6,7,10,11,12,13,17,20,22,23,25,27).Ein direkter Vergleich zwischen retrograder und transseptaler Sondierung bei Aortenstenose liegt nicht vor. Allerdings gibt es keine Hinweise dafür, daß transseptal weniger Komplikationen auftreten.…”

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Risiko der invasiven Diagnostik mit retrograder Sondierung des linken Ventrikels bei Patienten mit erworbener Aortenklappenstenose

et al. 1999

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In patients with aortic valve stenosis, the determination of the transstenotic pressure gradient is usually performed by cardiac catheterization with retrograde passage of the aortic valve. The aim of this study was to determine retrospectively the risk of the invasive examination with retrograde catheterization of the left ventricle and predictors for an increased risk. From 1984 to 1995, 457 patients (63 +/- 11 years) with aortic stenosis were investigated in the Medizinische Klinik Tübingen. In 435 patients (95.2%), the retrograde catheterization of the left ventricle was successful; in 19 cases a transseptal left heart catheterization was performed, and in 3 patients an invasive determination of the pressure gradient was not assessed. Complications occurred in 39 patients (8.5%). 5 patients died due to the catherization procedure (mortality rate 1.1%), 2 of them as a consequence of perforation of the left ventricle, one patient of heart failure, one of myocardial infarction, and another of fulminant pulmonary embolism. Four procedures (0.9%) were complicated by cerebral embolism, in 3 patients a pericard tamponade occurred, and in one case caused by transseptal punction of the interatrial septum. The most complications were peripheral vascular problems in 19 patients (4.2%). Predictors for increased risk dur to retrograde catheterization were age > 70 years (p = 0.008) and aortic valve area < or = 0.7 cm2 (p = 0.02). patients with a doppler echocardiographic instantaneous pressure gradient > or = 70 mm Hg were more likely to sustain a complication (p = 0.04). The retrograde catheterization of a stenotic aortic valve was successful in most cases. In approximately 2% of patients, complications occurred which can be attributed directly to retrograde catheterization and with significant higher frequency in patients over 70 years and with severe stenosis. Especially in these cases, invasive determination of the gradient should not be performed if reliable doppler echocardiographic information is available.

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Risiko der invasiven Diagnostik mit retrograder Sondierung des linken Ventrikels bei Patienten mit erworbener Aortenklappenstenose

et al. 1999

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Transseptal Left Heart Catheterization

Rosenberg¹

2005

Cardiac Catheterization in Congenital Heart Disease: Pediatric and Adult

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Left heart catheterization by puncture of the atrial septum was introduced by Manfredi (1956) and elaborated by Ross (1959). We have investigated 65 patients by this method and present our results with particular reference to its safety and effectiveness.SUBJECTS AND METHODThe majority of the patients had rheumatic heart disease ( Table I). The age range was 9 to 67 years and the distribution is shown in Table II. There were three patients under 17 years of age. The size of the left atrium was graded on X-ray (penetrated postero-anterior, right lateral, and right anterior oblique views with barium in the cesophagus) and was found to be normal in 11, slightly enlarged in 23, moderately enlarged in 29, and aneurysmal in 2 patients.The basic technique of transseptal left atrial puncture used was that described by Ross, Braunwald, and Morrow (1960). Briefly, this consists of introducing a 595 cm. long catheter into the right atrium from the right saphenous vein, threading the 61 cm. transseptal needle (Fig. 1) through the catheter and puncturing the septum in the region of the fossa ovalis with the needle. It has not always been found possible to make contact with the atrial septum in the lower half of the right atrial shadow as advised by Ross since a small left atrium frequently lies higher. When this is the case it is considered especially important to maintain the 450 posterior slant of the needle at puncture since the aorta is at the same level but anterior to the left atrium.The entire procedure is done under fluoroscopic control, and blood samples and pressure pulses are taken through the needle immediately before and after the puncture to confirm the position of its tip.When, in ten of the earlier cases of the series, information was required from the left ventricle as well as the atrium, an attempt was made to obtain it by passing a thin polythene tube through the needle once its tip was lying in the left atrium . This procedure was unsatisfactory in our laboratory and was abandoned in favour of advancing the large catheter over the needle after the tip of the needle has been introduced into the atrium. The procedure evolved in our laboratory whereby the needle is held stationary while the catheter is advanced differs slightly from that described by Brockenbrough and Braunwald (1960) and Gorlin et al. (1961) in which the needle and catheter are advanced together for a short distance with the needle point protruding before the catheter is further advanced over the needle. Once the catheter is in the left atrium the needle is withdrawn to the point of puncture and the catheter advanced into the ventricle. The needle is then removed and all the pressure measurements under rest and exercise conditions and the blood samples required in the individual case are obtained, and contrast injection is performed if indicated.When right heart catheterization was indicated it was performed through the same vein either after the left heart catheterization (40 patients) or simultaneous with it (6 patients). The bleeding tha...

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Transcatheter creation of an atrial septal defect using radiofrequency perforation

Justino

Benson

Nykanen

2001

Cathet Cardio Intervent

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

Cited by 11 publications

References 14 publications

Risiko der invasiven Diagnostik mit retrograder Sondierung des linken Ventrikels bei Patienten mit erworbener Aortenklappenstenose

Risiko der invasiven Diagnostik mit retrograder Sondierung des linken Ventrikels bei Patienten mit erworbener Aortenklappenstenose

Transseptal Left Heart Catheterization

Transcatheter creation of an atrial septal defect using radiofrequency perforation

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