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Morais P, Vilaça JL, Ector J, D'hooge J, Tavares JMRS. Novel Solutions Applied in Transseptal Puncture: A Systematic Review. J Med Device 2017. [DOI: 10.1115/1.4035374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
- Pedro Morais
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal
- Lab on Cardiovascular Imaging and Dynamics, KU Leuven, Leuven 3000, Belgium
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - João L. Vilaça
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães 4710-057, Portugal
- DIGARC—Polytechnic Institute of Cávado and Ave, Vila Frescainha S. Martinho Barcelos 4750-810, Portugal
| | - Joris Ector
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan D'hooge
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - João Manuel R. S. Tavares
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Departamento de Engenharia Mecânica, Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, Porto 4200-465, Portugal e-mail:
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Wang Y, Chen G, Bai Y, Li S, Natale A, Dong J, Wang H, Sang C, Yu R, Long D, Tang R, Liu X, Zhao X, Jiang Y, Ma C, Wang DW. Transseptal puncture by CTP-2 method: Results from cardiac computed tomography analysis and clinical application. Medicine (Baltimore) 2016; 95:e4504. [PMID: 27559952 PMCID: PMC5400318 DOI: 10.1097/md.0000000000004504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The current used parameters for transseptal puncture (TSP) under fluoroscopic guidance is from left atriography and need to be verified by precise anatomic measurement. From February 2009 to July 2013, consecutive patients who received computed tomography (CT) were included. Landmarks and parameters were preliminary studied by right atriography, and further evaluated on the CT images of 1001 patients. A method (CTP-2) was proposed for guiding TSP. In right anterior oblique 45° view, the CTP-2 method was defined by points C, T, and P, and 2 areas: point C is in coronary sinus; point T is at a distance of dCT (usually 1.5 ± 0.2 vertebral height) over point C; then point P, the optimal puncture site, was located at 0.5 ± 0.2 vertebral body height posterior to point T; puncture should avoid the aortic root area and the rear triangle area; the aortic root area could be negatively revealed by right atriography at the orifice of inferior vena cava, and the rear triangle area is demarcated by points C, C', and T' (C' and T' are 2 points horizontally posterior to, and at dCT away from points C and T, respectively). The initial application of CTP-2 in 2820 patients showed that it might be helpful in reducing the need of left atriography and the possibility of cardiac perforation.
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Affiliation(s)
- Yan Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Yan Wang and Dao Wen Wang, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (e-mail: [YW] and [DWW])
| | - Guangzhi Chen
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Bai
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Li
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Hong Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Ronghui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Xingpeng Liu
- Heart Center, Center for Atrial Fibrillation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
| | | | | | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University
| | - Dao Wen Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Yan Wang and Dao Wen Wang, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (e-mail: [YW] and [DWW])
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Chik WW, Robinson D, Ross DL, Thomas SP, Kovoor P, Thiagalingam A. First-in-human case of repeat pulmonary vein isolation by targeting visual interlesion gaps using the direct endoscopic ablation catheter after single ring pulmonary vein isolation. HeartRhythm Case Rep 2015; 1:279-284. [PMID: 28491568 PMCID: PMC5419525 DOI: 10.1016/j.hrcr.2014.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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HOWARD STEPHENA, QUALLICH STEPHENG, BENSCOTER MARKA, HOLMGREN BRYCEC, ROLFES CHRISTOPHERD, IAIZZO PAULA. Tissue Properties of the Fossa Ovalis as They Relate to Transseptal Punctures
: A Translational Approach. J Interv Cardiol 2015; 28:98-108. [DOI: 10.1111/joic.12174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- STEPHEN A. HOWARD
- Department of Biomedical Engineering; University of Minnesota; Minneapolis Minnesota
- Medtronic, Inc.; Mounds View Minnesota
| | - STEPHEN G. QUALLICH
- Department of Biomedical Engineering; University of Minnesota; Minneapolis Minnesota
- Department of Surgery; University of Minnesota; Minneapolis Minnesota
| | - MARK A. BENSCOTER
- Department of Biomedical Engineering; University of Minnesota; Minneapolis Minnesota
- Medtronic, Inc.; Mounds View Minnesota
| | - BRYCE C. HOLMGREN
- Department of Biomedical Engineering; University of Minnesota; Minneapolis Minnesota
- Department of Surgery; University of Minnesota; Minneapolis Minnesota
| | - CHRISTOPHER D. ROLFES
- Department of Biomedical Engineering; University of Minnesota; Minneapolis Minnesota
- Department of Surgery; University of Minnesota; Minneapolis Minnesota
| | - PAUL A. IAIZZO
- Department of Biomedical Engineering; University of Minnesota; Minneapolis Minnesota
- Department of Surgery; University of Minnesota; Minneapolis Minnesota
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CHIK WILLIAMW, BARRY MA, MALCHANO ZACH, WYLIE BRYAN, POULIOPOULOS JIM, HUANG KAIMIN, LU JUNTANG, THAVAPALACHANDRAN SUJITHA, ROBINSON DAVID, SAADAT VAHID, THOMAS STUARTP, ROSS DAVIDL, KOVOOR PRAMESH, THIAGALINGAM ARAVINDA. In Vivo Evaluation of Virtual Electrode Mapping and Ablation Utilizing a Direct Endocardial Visualization Ablation Catheter. J Cardiovasc Electrophysiol 2011; 23:88-95. [DOI: 10.1111/j.1540-8167.2011.02169.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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SMELLEY MATTHEWP, SHAH DIPAKP, WEISBERG IAN, KIM SUSANS, LIN ALBERTC, BESHAI JOHNF, BURKE MARTINC, KNIGHT BRADLEYP. Initial Experience Using a Radiofrequency Powered Transseptal Needle. J Cardiovasc Electrophysiol 2010; 21:423-7. [DOI: 10.1111/j.1540-8167.2009.01656.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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TZEIS STYLIANOS, ANDRIKOPOULOS GEORGE, DEISENHOFER ISABEL, HO SIEWYEN, THEODORAKIS GEORGE. Transseptal Catheterization: Considerations and Caveats. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:231-42. [DOI: 10.1111/j.1540-8159.2009.02598.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Eversull CS, Lin B, Irani AR, Quigley ML, Mourlas NJ, Hsia HH, Zei PC, Al-Ahmad A, Wang PJ. Direct Visualization of Cardiac Radiofrequency Ablation Lesions. J Cardiovasc Transl Res 2009; 2:198-201. [DOI: 10.1007/s12265-009-9094-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 02/20/2009] [Indexed: 10/21/2022]
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