Key result
Transseptal puncture remains feasible for left heart interventions despite prior ASD closure devices.
Why the study?
Transseptal puncture for left heart structural interventions is challenging in patients with prior atrial septal defect closure devices, requiring detailed anatomical understanding and imaging guidance.
Case Report (n=2)
May enable left-sided interventions after ASD closure; leaves open need for prospective safety data.
A transseptal puncture is critical for "left-sided" structural heart interventions. Procedures such as transcatheter edge-to-edge repair (MitraClip) and left atrial appendage (LAA) closure (Watchman) require precise puncture of the interatrial septum (IAS), and the presence of a prior atrial septal defect (ASD) closure device poses a challenge. We aim to present a successfully completed case of MitraClip and Watchman in the presence of ASD closure device in two different patients. A review of the literature will be reported, and pertinent clinical and technical considerations will be discussed in depth to achieve procedural success. In summary, transseptal puncture for left heart structural interventions is feasible in the presence of a prior ASD/patent foramen ovale closure device. A detailed understanding of the anatomical considerations as well as the use of multimodality imaging to evaluate the IAS will aid in improving procedural success rates.
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Yap et al. (2019) conducted a case report in Prior atrial septal defect closure requiring left-sided structural heart interventions (n=2). Transseptal puncture in the presence of a prior ASD closure device was evaluated on Procedural feasibility and success. Transseptal puncture for left heart structural interventions like MitraClip and Watchman is feasible and can be successfully completed in the presence of a prior ASD closure device.
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