Recent experience with transeptal catheterization

The technique and safety of transseptal left heart catheterization: the Massachusetts General Hospital experience with 1,279 procedures

With the introduction of interventional procedures such as percutaneous mitral valvuloplasty and radiofrequency ablation of left-sided bypass tracts, there has been renewed interest in the technique of transseptal left heart catheterization. We review our experience with 1,279 transseptal catheterizations performed over the last 10 years. The most common indications for transseptal catheterization included direct measurement of left atrial pressure or access to the left ventricle in patients with prosthetic aortic or mitral valves, and in patients undergoing percutaneous mitral valvuloplasty. A total of 17 major complications occurred (1.3%), including cardiac tamponade (15 patients, 1.2%), systemic emboli (1 patient, 0.08%), and death secondary to aortic perforation (0.08%). We conclude that when performed by experienced operators, transseptal left heart catheterization is associated with low morbidity and mortality.

Atrial septostomy: stationary angioplasty balloon technique--experimental work and preliminary clinical applications

A new approach to creating an interatrial communication using a stationary fixed-diameter angioplasty balloon is presented. Stationary balloon septostomy was used to create an atrial communication in 19 young swine using a transseptal technique through a closed atrial septum, and in 18 newborn lambs through a patent foramen ovale. In animals with an intact septum, there was persistent patency of the atrial communication using balloons larger than 12 mm in diameter. The average diameter of the atrial communication was 96% of the expanded diameter of the angioplasty balloon. For newborn lambs with a patent foramen, a smooth oval atrial communication was noted by 4 weeks, and there was persistent patency of the opening using balloons larger than 15 mm in diameter. The average diameter of the opening was 81% of the diameter of the angioplasty balloon used. The new procedure was used successfully in five patients. All five showed resolution of the clinical symptomology. In conclusion, stationary angioplasty balloon atrial septostomy has been effective in producing interatrial communications, which remained patent for 4-14 weeks, in animals with intact septum, as well as in those with a patent foramen ovale.

Left heart catheterization by direct ventricular puncture: withstanding the test of time

If retrograde arterial catheterization of the left ventricle fails because of a stenosed native or tissue valve or is contraindicated because of the presence of a mechanical aortic prosthesis, then alternative routes of access to the left ventricle are either transseptal or direct (transapical) left ventricular puncture. The transseptal approach is contraindicated in the presence of a mechanical mitral valve prosthesis. Under these circumstances we have used direct transapical left ventricular puncture in the treatment of 112 patients and have found this technique to be successful with little associated risk. A major complication occurred in 3% of the patients, but the study provided the required data in 95%, and these figures compare favorably with the reported results of transseptal catheterization.

Transseptal left heart catheterization: a review of 278 studies

In our laboratory, we performed 278 transseptal left heart catheterizations in adult patients over a period of 13 years. The left atrium was entered in 91.4% of the intended left heart catheterizations. Of 252 attempts, the left ventricle was entered in 96.1%. Major complications were aortic puncture (0.7%), pericardial puncture/suspected tamponade (3.2%), systemic arterial embolism (1.1%), and suspected perforation of the inferior vena cava (0.4%). There were no deaths. Although less frequently performed during the last decade, the transseptal catheterization technique has a complication rate of the same magnitude as during periods when this method was more commonly applied.