Elsevier

American Heart Journal

Volume 151, Issue 1, January 2006, Pages 235-241
American Heart Journal

Clinical Investigation
Vascular and Congenital Heart Disease
Immediate and late outcomes of patients undergoing transseptal left-sided heart catheterization for symptomatic valvular and arrhythmic diseases

https://doi.org/10.1016/j.ahj.2005.02.034Get rights and content

Background

The transseptal technique has been widely used for diagnostic and therapeutic left-sided heart catheterization. However, its differential immediate and late outcomes among patients with various valvular and arrhythmic diseases are not yet determined.

Methods

Beginning from 1993, all patients undergoing transseptal procedures were screened and categorized into diagnosis, arrhythmia, and valvuloplasty groups according to the purposes of the catheterization. Incidences of transseptum-related acute major events (cardiac perforation, embolic stroke, and bradyarrhythmia during the procedure) and late complications (residual atrial septal defect [ASD], embolic stroke, bradyarrhythmia, and death up to 18 months) were analyzed and compared between groups.

Results

From January 1993 to May 2003, a total of 176 patients underwent 184 transseptal procedures for diagnosis of valvular heart diseases (n = 8), catheter ablation of arrhythmogenic foci (n = 29), and mitral valvuloplasty (n = 147). The immediate outcome was similar among the 3 groups, with an overall acute complication incidence of 3.8%. At follow-up, the incidences of bradyarrhythmia, embolic stroke, and death were not different among the 3 groups. Patients undergoing valvuloplasty had a significantly higher prevalence of residual ASD, especially for those with more severe mitral stenosis and less valvuloplasty success. However, presence of ASD did not impose disadvantage over the 1.5-year prognosis.

Conclusion

Transseptal left-sided heart catheterization can be safely applied to patients with different categories of cardiac diseases with comparably good immediate and late outcomes. Although patients undergoing percutaneous valvuloplasty have a higher chance of permanent ASD creation, their prognosis is not influenced.

Section snippets

Patients

Beginning from January 1993, all patients undergoing transseptal left-sided heart catheterization for diagnosis or treatment of symptomatic valvular or arrhythmic disorders were screened. Standard disciplines for transseptal procedures in this institution include detailed preprocedural evaluation and postprocedural follow-up. Before the procedure, all patients received transthoracic Doppler echocardiography as a routine study, with provisional transesophageal echocardiography done when there

Immediate outcomes

From January 1993 to May 2003, of the 21 719 cardiac catheterizations performed in this tertiary referral hospital, a total of 176 patients (75 men, age 15-82 years, mean 55 years) underwent 184 transseptal procedures for the intentions of diagnosis of severity of valvular diseases (diagnosis group n = 8), catheter ablation of arrhythmic foci (arrhythmia group n = 29, including 13 patients requiring 2 transseptal punctures for pulmonary vein isolation), and mitral valvuloplasty (valvuloplasty

Discussion

Although invented decades earlier, the transseptal technique still plays an important and often indispensable role in current left-sided heart catheterization. In this study exploring the short- and long-term outcomes of patients undergoing a transseptal procedure for diagnostic and therapeutic purposes, we demonstrated that this technique is equivalently safe and feasible both immediately and in the long term for patients with various categories of left-sided cardiac diseases and large spans

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