Transseptal puncture — Review of anatomy, techniques, complications and challenges

O’Brien, Barry; Zafar, Haroon; Freitas, Simon De; Sharif, Faisal

doi:10.1016/j.ijcard.2017.02.009

Cited by 62 publications

(41 citation statements)

References 91 publications

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“…There is also the potential downside of difficulty with trans‐septal puncture for future procedures. However, generally, transseptal puncture is still possible through an adjacent area of the septum (typically infero‐posteriorly) or even through the closure device if needed …”

Section: Discussionmentioning

confidence: 99%

“…However, generally, transseptal puncture is still possible through an adjacent area of the septum (typically infero-posteriorly) or even through the closure device if needed. [16][17][18][19] It has been proposed that the creation of an iatrogenic ASD in patients with elevated left sided pressures could potentially have a beneficial hemodynamic effect in patients with left ventricular diastolic dysfunction by relieving the elevated left sided pressures by allowing flow to the right atrium. The fact that Schueler et al reported patients with persistent iASDs had worse outcomes may argue against iASDs being beneficial long term in patients without diastolic heart failure or with systolic heart failure.…”

Section: Discussionmentioning

confidence: 99%

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Iatrogenic atrial septal defect closure after transseptal mitral valve interventions: Indications and outcomes

Beri

Singh

Smith

et al. 2019

Cathet Cardio Intervent

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Objectives Review indications and outcomes for transcatheter iatrogenic atrial septal defect (iASD) closure in patients undergoing MitraClip or transseptal (TS) mitral valve‐in‐valve/ring (ViV/ViR) procedures. Background Mitral valve transcatheter interventions require large‐diameter TS sheaths that can result in iASDs that necessitate post‐procedure transcatheter closure. Although the presence of iASD has been well‐described, indications for closure and outcomes after TS mitral valve interventions have not been reported. Methods Patients undergoing MitraClip repair and ViV or ViR transcatheter mitral valve replacement (TMVR) from February 14, 2014, to January 16, 2018, were studied retrospectively in this single center study. Results Seventeen patients had iASD closure: 11 MitraClip and 6 TMVR (5 ViV, 1 ViR). Indications for iASD closure included large iASD (n = 7), large left‐to‐right shunt (n = 9), pulmonary hypertension (n = 8), large right‐to‐left shunt (n = 1), severe RV dysfunction (n = 2), thin/aneurysmal septum (n = 2), and mobile material on pacemaker leads (n = 2). Closures were performed without complications using Amplatzer septal occluders. At 30 days, 94% of subjects (n = 16) were alive with one patient deceased from unknown causes. There were no myocardial infarctions or strokes. At 12 months, follow‐up was available for 14 of 17 patients, and 71% of patients (10/14) were alive. One patient died due to cardiac causes, two from noncardiac causes and one for unknown reasons. There was one myocardial infarction, one intraparenchymal hemorrhage, and no ischemic strokes. Conclusions The most common reasons for iASD closure after TS MV procedures are: large ASD unlikely to spontaneously close, large left‐to‐right shunt, and pulmonary hypertension. Patients who required iASD closure had low 30‐day mortality but higher one‐year mortality potentially reflecting a population with substantial comorbidities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Iatrogenic atrial septal defect closure after transseptal mitral valve interventions: Indications and outcomes

Beri

Singh

Smith

et al. 2019

Cathet Cardio Intervent

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“…ITLs after invasive procedures requiring transseptal puncture are one of the most common long‐term complications. The incidence of ITL is associated with transseptal sheath size, long procedural time, high pulmonary pressure, and manipulation of the catheter . Previous data have shown that larger devices are more liable to produce symptomatic defects than smaller ones .…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Previous data have shown that larger devices are more liable to produce symptomatic defects than smaller ones. 5,6 The size of the sheath used during LAAO is 8F or 12F depending on the device size. In comparison showed left to right shunts through the atrial septum that were not related to any adverse events at 1 year of observation.…”

Section: Discussionmentioning

confidence: 99%

The influence of iatrogenic interatrial septum leaks after left atrial appendage closure on cardiac function test results

Mitręga

Streb

Szymała

et al. 2018

J Interven Cardiology

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“…The transseptal puncture is commonly performed during cardiac interventions, although we have observed an increase in the number of procedures using this access to the left heart chambers (1). The clinical anatomy of the interatrial septum is difficult, and its lack of familiarity can cause serious complications.…”

mentioning

confidence: 99%

Radiationless transseptal puncture

Hołda¹

2017

Anatol J Cardiol

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Transseptal puncture — Review of anatomy, techniques, complications and challenges

Cited by 62 publications

References 91 publications

Iatrogenic atrial septal defect closure after transseptal mitral valve interventions: Indications and outcomes

Iatrogenic atrial septal defect closure after transseptal mitral valve interventions: Indications and outcomes

The influence of iatrogenic interatrial septum leaks after left atrial appendage closure on cardiac function test results

Radiationless transseptal puncture

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