Devices, techniques, and considerations for specific interventions. Conclusionatrial septal puncture for transseptal catheterization is always guided correctly by prior three view fluoroscopic observation of the relationship between the brockenbrough needle tip and the catheter placed in the aorta. In addition, the entire transseptal needle is inspected as it lies on the table top to make certain that the needle tip and the arrow indicator at the other end of the needle are in the same plane. Landmarks and parameters were preliminary studied by right atriography, and further evaluated on the ct images of. A simplified transseptal puncture technique using a needle free approach for cryoablation of atrial fibrillation shohreh honarbakhsh1, ben obrien2, richard j schilling3 1this author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Femoral puncture both groins should be prepared because invasive arterial monitoring might be needed should any complication occur. Transseptal puncture is a wellknown and widelyused procedure, providing percutaneous access to the left atrium of the heart. A very small distance from the interatrial septum to the left atrial free wall. Successful left atrial appendage closure in a patient with. Comparison of the retrograde and transseptal methods for. Aug 25, 2020 dextrocardia is a rare congenital condition in which the apex of the heart is located on the right side of the body. Transcoronary sinus puncture for catheter ablation and. Mccauley md1, patel n2, greenberg sj3, molinarazavi je3, safavinaeini p3, razavi m3. Distances between transseptal puncture site and anatomical. Transcoronary sinus puncture for catheter ablation and left. An alternative to the transseptal puncture is the retrograde transaortic approach. The art of transseptal puncture lost in translation.
Pdf intracardiac echocardiography for transseptal puncture. During the manipulation of transseptal puncture, a perforation of the free right atrial wall at the coronary sinus ostium occurred, which was caused by the brockenbrough needle and followed by the immediate advancement of an 8. A fluoroscopy free and echocardiography free method jacc cardiovasc interv. Preventing complicated transseptal puncture with intracardiac. Performing this procedure can be difficult and risky, especially in small children. Left heart catheterization by the transseptal route. The search was performed in pubmed, scopus and isi web of knowledge using the expression transseptal puncture. Recognizing and reacting to complications of transseptal. I was pleased to learn later that this case was the firstever transseptal puncture using this rf needle. An inner surface of the needle tip defines a passageway spanning at least a portion of the needle tip, and an outer surface of the needle tip.
The current used parameters for transseptal puncture tsp under fluoroscopic guidance is from left atriography and need to be verified by precise anatomic measurement. Department of medicine, section of cardiology, the university of illinois at chicago and. Us8114110b2 transseptal puncture needle and needle. If they are not, puncture of the free wall of the right atrium or of the ascending aorta may complicate attempted atrial septal puncture. How to perform a transseptal puncture thoracic key. The distance between the atrial septum and the mitral valve index during needle rotations. Aug 27, 2018 transseptal puncture the right femoral vein short sheath is exchanged using a long 0. Rf transseptal puncture was achieved at the first attempt in all patients within a median of 1 second interquartile range, 1 to 4 and without any complication. The guide wire exhibited an uncommon course and did not enter the ra from inferior.
The only parameter predictive of a septum resistant to conventional puncture was the total number of transseptal. From february 2009 to july 20, consecutive patients who received computed tomography ct were included. Threedimensional transesophageal echocardiography to. Transseptal techniques for emerging structural heart. Fluoroscopic guidance was effective, at both puncture levels. Transseptal puncture for radiofrequency catheter ablations of. The use of a standard radiofrequency energy delivery. A simplified transseptal puncture technique using a needle free approach for cryoablation of atrial fibrillation. These courses provide didactic and handson training designed for cardiothoracic surgeons who perform or are looking to perform transcatheter mitral valve. Transseptal puncture is used by electrophysiologists and interventional cardiologists to gain access through the fossa ovalis to the left atrium to treat different cardiac conditions. A transseptal needle includes an elongate needle body having a distal end and a proximal end and a cannular needle tip located proximate the distal end of the needle body. The atrial transseptal puncture tsp technique is an indispensable procedure in the invasive cardiac catheterisation laboratory. Originally regarded as a relatively risky venture, tsp was guided by fluoroscopy, directing a catheter tip to the fossa ovalis fo.
The results showed that the septum was successfully crossed in all patients receiving transseptal puncture with the rf needle, whereas 438 patients 11% in the mechanical needle. Novel solutions applied in transseptal puncture technique. However, a rightside venous femoral puncture is usually preferred for the tp procedure due to the more. Rf transseptal puncture nrg rf transseptal needle quick reference guide. Abstract objectives this study sought to define electrographic characteristics of the fossa ovalis fo and use these findings in developing a 3dimensional 3d. Transseptal puncture for structural heart procedures. Transseptal puncture for catheter ablation in children. Marked right atrial enlargement occuring in tricuspid regurgitation or stenosis may make transseptal puncture especially difficult. Pdf fluoroscopic guidance in transseptal catheterization. Institutional and operator requirements for left atrial. Fluoroscopyfree atrial transseptal puncture touchcardio. Fluoroscopy free atrial transseptal puncture mark d mccauley,1 nisarg patel,2 scott j greenberg,3 joanna e molinarazavi,3 payam safavinaeini3 and mehdi razavi3 1. Find, read and cite all the research you need on researchgate. Safety and effectiveness of a novel fluoroless transseptal puncture technique for lead free catheter ablation.
Transseptal puncture has historically involved pushing a sharp, mechanical needle across the interatrial septum to gain leftheart access. Transseptal puncture for structural heart intervention. Transseptal puncture with the coaxial transseptal cts needle in the left anterior oblique projection. Use of a novel sharptip, jshaped guidewire to facilitate transseptal catheterization. Fluoroscopic guidance in transseptal catheterization for percutaneous mitral balloon valvotomy. Transseptal puncture tp is used in pediatric patients to access the left atrium in leftsided arrhythmia catheter ablation.
Transseptal puncture level below the foramen ovale group 11. Courses cover transseptal access through vascular closure and are designed for early career electrophysiologists and electrophysiology fellows. Transseptal techniques for emerging structural heart interventions. Epub ahead of print transseptal puncture performed with the new needle free safesept guidewire. Oct 01, 2009 transseptal puncture the guide wire for the first transseptal sheath was introduced via the right femoral vein. Pdf transseptal catheterization update 1992 carlos ruiz. Expert faculty introduced attendees to transseptal tools and techniques in our foundations of transseptal puncture webinar. Catheterization of the left atrium to perform ablation of arrhythmia via transseptal puncture through transseptal access systems is gaining interest these days.
Transseptal left heart catheterization was then applied in clinical studies and prelimimary experienees with it were eneouragingz12 15 the method has now been employed in patients with various formns of heart disease. Us20060064062a1 transseptal puncture needles and needle. The transseptal approach for ablation of cardiac arrhythmias. The transseptal puncture tsp enables access to the left heart, through the fossa ovalis fo, both in electrophysiology and in cardiac interventional procedures. Transseptal puncture performed with the new needlefree safesept. Transseptal puncture is a critical procedural step in pursuing leftsided catheter. Safe and reproducibly effective transseptal puncture and access to the left atrium and ventricle is now a prerequisite for the practicing invasive electrophysiologist. Transseptal puncture for ablation of atrial fibrillation. Catheter ablation for the treatment of af is a safe and recognized therapy. Transseptal puncture is a routinely performed interventional cardiology procedure for an array of cardiac diseases.
The short sheath is removed over the wire, and the transseptal sheath and dilator are advanced over the wire under fluoroscopic guidance until the tip of the dilator is in the svc, at the level of the tracheal carina. Dextrocardia with situs solitus, in which the viscera are in the normal position, is often associated with additional congenital anomalies. Pdf how to perform transeptal puncture researchgate. Safety and effectiveness of a novel fluoroless transseptal. A simplified transseptal puncture technique using a. The needle tip has a distal segment, a proximal segment, and a longitudinal axis. Transseptal access education courses merit medical.
Over the next several decades, with the growing acceptance of retrograde catheterization of the left ventricle, and the development and expanding use of echocardiography, experience with tsp declined. Sometimes tsp can be technically demanding and carries the risk of severe complications in app. The benefits of rf for transseptal procedures ep lab digest. Another ep had referred me a patient with a difficult transseptal puncture for a leftsided ablation, and it was at this time that i began using an rf needle nrg transseptal needle, baylis medical. Catheter ablation of arrhythmias has been attempted in various ways since the first description of the technique in 1983. Transseptal puncture and catheter ablation in the left atrium in patients with dextrocardia may be challenging. In this study, we aimed to evaluate the safety and feasibility of tps in children. Possible complications associated with the transseptal puncture can occur in approximately 1% of procedures. Transseptal solutions in collaboration with leading clinicians, researchers, and scientists worldwide brings to the market a new steerable sheath with a novel approach of transseptal puncture and.
Department of medicine, section of cardiology, the university of illinois at chicago and the jesse brown va medical center, chicago, illinois, us. More recently, it is increasingly performed for transcatheter interventions on the mitral valve mitraclip procedure, annuloplasty or valve implantation. Fluoroscopy is traditionally used in atrial transseptal puncture tsp. The initial approaches included puncture of the left atrium suprasternal, posterior transthoracic or transbronchial and apical or subxiphoid puncture of the left ventricle. Transseptal puncture is a critical step in percutaneous laa occlusion, as puncture at an appropriate site provides a technical advantage for device positioning and deployment. Here, we describe a feasibility study of a zerofluoroscopy transseptal puncture zftsp technique utilising electroanatomical mapping eam and intracardiac echo ice in a small case series of patients undergoing ablation for atrial. Request pdf transseptal access for left atrial ablation. Atrial fibrillation af is the most common cardiac arrhythmia. Transseptal puncture has been used worldwide for percutaneous mitral commissurotomy pmc. The use of a standard radiofrequency energy delivery system. The technique of transseptal puncture tsp was developed by ross, braunwald.
Transseptal puncture needle and needle assemblies download pdf info publication number us8114110b2. A proposed maneuver to guide transseptal puncture using real. Stretching and increased force to traverse the septum are required with elastic, aneurysmal, or thickened interatrial tissue. Transseptal puncture tsp is routinely performed during treatment of atrial fibrillation af and other electrophysiology procedures.
Double transseptal puncture for catheter ablation of atrial. Transseptal puncture performed with the new needlefree. Transseptal puncture for structural heart procedures part 1. Cvi2017 was hosted by cardiovascular innovations foundation at the grand hyatt hotel denver, colorad. Despite its common use, the transseptal puncture process can be associated with serious complications, such as cardiac tamponade.
The use of a novel nitinol guidewire to facilitate transseptal puncture and left atrial catheterization for catheter ablation procedures. Transseptal puncture for radiofrequency catheter ablations. The use of the modified 1821gauge needle tip was to be sure than an inadvertent puncture of the free wall of the right or left atrium or the aorta was not followed by uncontrolled bleeding. Pdf the art of transseptal puncture lost in translation. Pdf on mar 12, 2015, nitish naik published how to perform transeptal. Gentle forward manual pressure is applied to sheath, dilator and needle. The transseptal cannula is intended for single use only. Use of a novel needle wire in patients undergoing transseptal. Pdf how to perform a transseptal puncture semantic scholar. This module complements fluoroscopy with ultrasound imaging modalities, intracardiac echo ice and transesophageal echocardiography tee, to help improve the. Learn the fundamentals of transseptal puncture and advance your transseptal skillset for leftsided structural heart procedures with the technical and clinical guidance of expert faculty.
Pdf the key to a successful catheterization of the left heart chambers is the safe transseptal puncture. Pdf transseptal catheterization update 1992 carlos. A simplified transseptal puncture technique using a needle free. Needle free transseptal cannula indications for use describe the transseptal cannula is used in conjunction with a transseptal guidewire to puncture the interatrial septum during a transseptal catheterization procedure to gain left heart access. Preferred sites of transseptal puncture during therapeutic catheterizationsthe. Transseptal left heart catheterization diseases of the chest. A simplified transseptal puncture technique using a needle. Historically, transseptal puncture was the first available technique to access the left atrium, mainly for the direct measurement of the left atrial and left ventricular pressures in the 1960s. Pdf new coaxial transseptal needle for creation of. Radiofrequency puncture of the fossa ovalis for resistant. Typically therefore, the puncture is more superior and slightly anterior in the presence of aortic and lower and more posterior in the presence of mitral valve disease. The fossa itself was abouting anteriorly to the noncoronary aortic. The catheterprobing techniques are not without risk transseptal puncture tp is a prerequisite for laablations. Rf transseptal puncture with the nrg transseptal needle n119 to patients undergoing transseptal puncture with a mechanical needle n38.
Successful transseptal puncture and cryoballoon pulmonary. Transseptal puncture is a standard means of catheter access to the left atrium via the venous system, but carries a risk of cardiac perforation. Between april 2012 and april 2018, a retrospective evaluation was conducted of the clinical. Presentation recorded at cardiovascular innovations 2017.
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