Transseptal Techniques for Emerging Structural Heart Interventions

Abstract

The development of new transseptal transcatheter interventions for patients with structural heart disease is fueling increasing interest in transseptal puncture techniques. The authors review contemporary transseptal puncture indications and techniques and provide a step-by-step approach to challenging transseptal access and procedural complications.

Mechanical circulatory support in patients with severe aortic stenosis and left ventricular dysfunction undergoing percutaneous coronary intervention

“…TandemHeart insertion carries the risk of adverse events related to transseptal catheterization (tamponade, air embolism, iatrogenic atrial septal defect, etc.) . Lung over‐ventilation, relative lung ischemia, brain hypo‐perfusion, and intraventricular thrombus formation are rare complications of MCS specific to VA‐ECMO …”

“…[16][17][18][19][20] TandemHeart insertion carries the risk of adverse events related to transseptal catheterization (tamponade, air embolism, iatrogenic atrial septal defect, etc.). 21 Lung over-ventilation, relative lung ischemia, brain hypo-perfusion, and intraventricular thrombus formation are rare complications of MCS specific to VA-ECMO. 15 The utility of various MCS in patients with severe AS undergoing planned or rescue PCI, balloon aortic valvuloplasty (BAV), or TAVR has been demonstrated.…”

Distances between transseptal puncture site and anatomical landmarks

“…The procedure can be especially challenging for inexperienced physicians . Regardless of the increasing availability of transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE), exclusively fluoroscopy‐guided puncture is still performed in many electrophysiology laboratories …”

“…Transseptal puncture (TSP) is the key step in accessing left atrium (LA) for catheter-based procedures, including arrhythmia ablation. [1][2][3][4] Despite the well-known technique inadvertent puncture of the aortic root or atrial posterior wall still happens in more than 1% of patients undergoing TSP. [5][6][7] The procedure can be especially challenging for inexperienced physicians.…”

“…[5][6][7] The procedure can be especially challenging for inexperienced physicians. 5 Regardless of the increasing availability of transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE), 2,[7][8][9] exclusively fluoroscopy-guided puncture is still performed in many electrophysiology laboratories. [3][4][5]10 Although the standard fluoroscopy-guided approach has been effectively used for many years distances between the TSP site and fluoroscopy landmarks have not been studied in detail.…”