Considerations Regarding the Technique for Transseptal Left Heart Catheterization

Improvements in the equipment and technique for transseptal left heart catheterization appear to have largely overcome the major problems and complications that have been encountered in recent years with this procedure. Improvements in equipment have included the addition of a stylet for the needle, modifications in the design of the catheter, and the use of a catheter tip occluder both for manipulation of the catheter within the left heart and to close the end hole during selective angiography. The steps employed for insertion of the catheter and needle were described in detail, and the use of landmarks such as the left main-stem bronchus, the spine, the left atrial shadow, and the aortic bulge was discussed. The indications for, and relative contraindications to, transseptal catheterization currently applied in this laboratory were also described. The relative contraindications consist of (1) a giant right atrium, (2) severe rotational anomalies of the heart or great vessels, and kyphoscoliosis; (3) marked dilation of the ascending aorta; (4) anticoagulant therapy, and (5) a history of recent systemic arterial embolization. Since the introduction of these technical changes and precautions, with the exception of one nonfatal aortic puncture, the problems previously encountered during transseptal catheterizations have been avoided in more than 350 consecutive transseptal left heart studies in this laboratory.