Transseptal left heart catheterization: A review of 278 studies

B‐Lundqvist, C.; Olsson, Sten‐Erik; Varnauskas, E

doi:10.1002/clc.4960090105

Cited by 57 publications

(22 citation statements)

References 28 publications

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“…Transseptal puncture has been an important source of PE and tamponade in procedures requiring LA access even in a primarily diagnostic catheterization setting: a review of 278 transseptal punctures revealed a 3.2% incidence of pericardial puncture with incipient or clinically significant tamponade (17). In general there has been a growing base of experienced operators in the past decade.…”

Section: Transseptal Puncturementioning

confidence: 99%

Iatrogenic Pericardial Effusion and Tamponade in the Percutaneous Intracardiac Intervention Era

Holmes

Nishimura

Fountain

et al. 2009

JACC: Cardiovascular Interventions

123

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The number, specific type, and complexity of percutaneous intracardiac procedures continue to evolve. Many of these procedures require left atrial access using transseptal techniques. These approaches carry with them the potential for pericardial effusion (PE) and cardiac tamponade, particularly in the setting when intraprocedural anticoagulation is being administered. PEs and even cardiac tamponade have been documented with both diagnostic as well as therapeutic procedures. When the effusion is a complication of an intracardiac procedure, it is usually the result of a cardiac perforation. The presentation depends on several factors including the structure that is perforated, the device that caused the perforation, the baseline hemodynamic status of the patient, and the level of anticoagulation present. The incidence has varied substantially although it has been recorded with essentially all intracardiac procedures, both diagnostic and therapeutic on both the right and left side of the heart. Prompt recognition is essential so that prevention of the transition from effusion to tamponade can be attempted (e.g., by reversing anticoagulation) or the hemodynamic collapse can either be averted or treated. Clinical, radiologic, and echocardiographic assessment are each important. Pericardiocentesis can be life-saving and is a core competency for all laboratories performing invasive cardiac procedures. Systems of care must include the knowledge base, equipment, and expert echocardiographic and interventional personnel. Collaboration with noninvasive colleagues and training interventionalists who perform intracardiac interventions, both electrophysiologists and interventional cardiologists, should be required as part of every invasive program.

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Section: Transseptal Puncturementioning

confidence: 99%

Iatrogenic Pericardial Effusion and Tamponade in the Percutaneous Intracardiac Intervention Era

Holmes

Nishimura

Fountain

et al. 2009

JACC: Cardiovascular Interventions

123

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“…The ICE-guided transseptal puncture can avoid potential life threatening complications including aortic puncture, pericardial tamponade, systemic arterial embolism, and perforation of the inferior vena cava [30]. …”

Section: Guidance Of Transseptal Accessmentioning

confidence: 99%

Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation

Biermann

Bode

Asbach

2012

Cardiology Research and Practice

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Accurate delineation of the variable left atrial anatomy is of utmost importance during anatomically based ablation procedures for atrial fibrillation targeting the pulmonary veins and possibly other structures of the atria. Intracardiac echocardiography allows real-time visualisation of the left atrium and adjacent structures and thus facilitates precise guidance of catheter-based ablation of atrial fibrillation. In patients with abnormal anatomy of the atria and/or the interatrial septum, intracardiac ultrasound might be especially valuable to guide transseptal access. Software algorithms like CARTOSound (Biosense Webster, Diamond Bar, USA) offer the opportunity to reconstruct multiple two-dimensional ultrasound fans generated by intracardiac echocardiography to a three-dimensional object which can be merged to a computed tomography or magnetic resonance imaging reconstruction of the left atrium. Intracardiac ultrasound reduces dwell time of catheters in the left atrium, fluoroscopy, and procedural time and is invaluable concerning early identification of potential adverse events. The application of intracardiac echocardiography has the great capability to improve success rates of catheter-based ablation procedures.

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“…7 Accurate visualisation of the fossa ovalis reduces the risk of complications. Especially less experienced operators may find ICE a better imaging modality then fluoroscopy, by its ability to visualise accurately the target for transseptal puncture, the fossa ovalis.…”

Section: Transseptal Puncturementioning

confidence: 99%

Clinical applications of intracardiac echocardiography in interventional procedures

Jongbloed

Schalij²,

Zeppenfeld³

et al. 2005

Heart

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A ccurate knowledge of the anatomy of intracardiac structures is essential for the efficiency and safety of performing interventional procedures. Although fluoroscopy is an important aid while advancing catheters in the heart, it is not sufficient to supply accurate anatomical information on the position of veins, ridges, and septa in the heart. Furthermore radiation exposure forms a risk to both the patient and the operator.Intracardiac echocardiography (ICE) is a promising technique for imaging of intracardiac structures, and may serve as an alternative for the transoesophageal approach, 1 which is semiinvasive and requires anaesthesiology. The introduction of ICE catheters with low frequencies allows accurate visualisation of intracardiac anatomical structures with an ultrasound catheter placed exclusively in the right side of the heart. This report focuses on the use of ICE in guiding percutaneous interventional procedures. BASICS OF INTRACARDIAC ECHOCARDIOGRAPHY cHistory of two dimensional intracardiac ultrasound systems The first application of ICE was done using mechanical ultrasound systems, which were introduced in the 1980s. These systems provided high resolution imaging, but because of the high frequency of the transducers (20-40 MHz), tissue penetration was only limited and anatomic intracardiac overviews could not be obtained. The subsequent development of lower frequency transducers allowed imaging of intracardiac structures, but these systems were still limited by the low steerability and over-the-wire design of the catheters. 2 The clinical use was improved by the development of flexible lower frequency transducers (9 MHz), but depth control of these catheters still was not sufficient to allow visualisation of the whole heart from the right side of the heart. In the 1990s, systems modified after transoesophageal echocardiographic probes were introduced. In these systems depth was improved by the use of lower frequencies (5 MHz). However, the large size of these transducers limited the clinical use. In recent years the development of steerable phased array ultrasound catheter systems with low frequency and Doppler qualities has expanded the clinical use of ICE.

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Transseptal left heart catheterization: A review of 278 studies

Cited by 57 publications

References 28 publications

Iatrogenic Pericardial Effusion and Tamponade in the Percutaneous Intracardiac Intervention Era

Iatrogenic Pericardial Effusion and Tamponade in the Percutaneous Intracardiac Intervention Era

Intracardiac Echocardiography during Catheter-Based Ablation of Atrial Fibrillation

Clinical applications of intracardiac echocardiography in interventional procedures

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