Cardiac transseptal catheterisation

Summary

Atrial transseptal puncture was developed to provide precise left-heart haemodynamics for the assessment of valve disease. This use was replaced by echocardiography, but it continued to be used for aortic and mitral balloon valvuloplasty and left-heart pathway ablations. Over the past decade, the role of transseptal puncture has increased greatly for atrial fibrillation ablations, transcatheter repair of mitral regurgitation, closure of some patent foramen ovales, left atrial appendage obliteration, paraprosthetic valve leak repair, positioning of left ventricular assist devices, pulmonary vein stenting, and resynchronisation therapy. This resurgence has been accompanied by new devices and variations in the classic technique. While fluoroscopy is still largely used to guide transseptal puncture, intraprocedural echocardiography has become widely used in specific interventions.

Introduction

The objective of atrial transseptal puncture is the safe and effective delivery of catheterisation equipment from the right atrium (RA) to the left heart. It was introduced into clinical practice in 1959 by Ross, Morrow and Braunwald 11. Ross J, Jr. Transeptal left heart catheterization: a new method of left atrial puncture. Ann Surg. 1959; 149:395-401. Link. Its initial use was to provide precise haemodynamic measurements to help in the selection of patients for cardiac valve surgery. It allowed...