What is the safety profile of transseptal catheterization guided by precatheterization echo and radiological techniques in patients with valvular heart disease?
Transseptal catheterization guided by precatheterization imaging is a safe procedure with very low morbidity and zero mortality in patients with valvular heart disease.
Resurgence of the transseptal procedure in the last decade has occurred coincident with the advent of therapeutic catheterizations and in particular mitral balloon vavuloplasty. As larger numbers of these procedures have been performed, experience shows that the position of intended septal puncture varies for each anticipated procedure and need not lie at the fossa ovalis, which is frequently displaced or inaccessible. Recognizing the dynamic alterations in septal and atrial anatomy that accompany the various combinations of valvular heart disease, the experienced interventionalist will use precatheterization echo and radiological techniques to enable precise and localized transseptal puncture. Using these techniques in 597 patients for valvular heart disease, we have had no deaths and a morbidity of 1.8% with the transseptal puncture.
Clugston et al. (Sat,) studied this question.