Antegrade selective coronary angiography via the transseptal approach in a patient with severe vascular disease

Abstract

We describe a case of a woman with severe vascular disease in whom retrograde access to the aortic root was limited by both aortoiliac and axillary disease. Transseptal catheterization was performed in anticipation of percutaneous aortic valvuloplasty. Selective antegrade angiography was successfully performed using catheters introduced through the transseptal sheath.

Transseptal Coronary Angioplasty in Patients with Severe Peripheral Vascular Disease

“…After the hydrophilic guide was retrieved and the 0.035" stiff 300 cm guide was passed, the catheter was exchanged. As described in the previous case 3,4 , catheter Amplatzer Left 1 (Launcher®, Medtronic Inc.) was initially used unsuccessfully in the left coronary artery catheterization. Catheterization was possible with the catheter Amplatzer Right 2 (Launcher®, Medtronic Inc.).…”

Antegrade transseptal coronary angiography: An alternative technique in severe vascular disease

“…The procedure was initially attempted through the radial approach, but the catheter could not be advanced on either side because of bilateral subclavian occlusion. Therefore, we elected to attempt antegrade coronary angiography through a transseptal approach, as described by Pearce et al [2].…”

“…The balloon catheter was exchanged over a 0.038-in. guidewire for a 6-French Amplatz L-1 diagnostic catheter (Cordis Europa, Roden, The Netherlands), as previously described [2]. However, selective engagement of the left main stem was not possible, and the Amplatz L-1 was exchanged for a 6-French Multipurpose diagnostic catheter (Cordis).…”

“…In patients with peripheral vascular disease, a brachial or radial approach is often used. However, other techniques are required in cases of arterial occlusive disease affecting all four extremities, and Pearce et al reported the first case of selective coronary angiography performed through a transseptal approach in 1992 [2]. Current indications for transseptal left heart catheterisation, originally reported by Brockenbrough et al in 1962 [3], include the evaluation of aortic and mitral valve function, diagnosis of congenital abnormalities, and antegrade mitral and aortic valvuloplasty.…”

Commentary: Transcardiac Access to the Ascending Aorta and Beyond

“…More recently, Joseph et al 11,12 described how ascending aortic access obtained through a long transseptal sheath kept steady by a taut indwelling guidewire can be used to facilitate endograft passage in the aortic arch by pull-down with a snare, or to embolize type I proximal endoleak in a bird-beaked aortic arch endograft. Other workers have also reported using the transseptal approach successfully to perform similar interventions 13,14 or for selective coronary angiography, 15,16 attesting to the feasibility and reproducibility of the transseptal technique.…”