Search Results (3)

Transseptal puncture (TSP) is a critical technique for accessing the left atrium in various structural and electrophysiological cardiac procedures. Originally introduced for diagnostic catheterization in the mid-20th century, it has evolved into a cornerstone of modern interventional cardiology. This article was designed as a targeted narrative review, rather than a systematic or comprehensive review, and synthesizes selected peer-reviewed evidence spanning 1955 to 2025, retrieved through a targeted literature search. We explore the anatomical foundations of TSP, its historical development, and modern refinements such as radiofrequency-assisted puncture, balloon septoplasty, and fluoroless or image-fusion-guided access. Clinical applications—including mitral valve interventions, left atrial appendage closure, and decompression during extracorporeal membrane oxygenation (ECMO)—are reviewed alongside safety considerations and complication management strategies. Advances in imaging modalities, including three-dimensional echocardiography and computed tomography, have enhanced precision and safety. Because of the narrative design, the review emphasizes clinical relevance, procedural applicability, and evidence synthesis without formal risk-of-bias scoring or quantitative evidence grading. Overall, TSP demonstrates a high success rate and low complication profile when performed with appropriate imaging and operator expertise. Ongoing innovation in technique and technology continues to expand its utility across cardiac disciplines. Full article

Background: Echocardiography is the primary assessment tool for follow-up in patients with aortic valve prostheses. However, there are concerns regarding the consistency between echocardiographic and invasive transvalvular gradients (TVGs). This study utilized both noninvasive and invasive methods to compare the TVGs in aortic valve prostheses. Methods: The study included fourteen patients who had previously undergone surgical aortic valve replacement [metallic (n = 12) and bioprosthetic (n = 2)]. All patients had moderate-to-severe TVGs, which were measured during follow-up echocardiography, and they underwent invasive transseptal catheterization. Invasive and echocardiographic TVGs were measured and compared. Results: The median interval between index valvular surgery and invasive TVG measurement was 6.7 (2.5–11.5) years. The median interval between echocardiographic and invasive TVG measurements was 7.2 (2–19) days. Only 12 (85.7%) patients were symptomatic during echocardiographic assessment. Maximum TVGs obtained by echocardiography were higher than invasive peak-to-peak TVGs (77.0 ± 13.1 vs. 47.5 ± 21.7 mmHg, p < 0.05). There was a significant negative correlation between the echocardiography-based aortic valve area and the effective orifice area index with the catheter-based peak-to-peak aortic gradient (r = −0.64, p = 0.014 and r = −0.63, p = 0.015). Six patients (42.9%) who revealed severe catheter-based peak-to-peak aortic gradient underwent redo aortic valve surgeries. The cut-off value of EOAI of <0.50 cm²/m² was found to be a predictor of severe catheter-based peak-to-peak aortic gradient. Conclusions: In our preliminary cohort study, the TVGs of aortic valvular prostheses measured by echocardiography were significantly greater than those measured by invasive transseptal catheterization. During follow-up, invasive confirmation of echocardiographic moderate-to-severe TVGs in selected patients with surgical aortic valvular prostheses may be considered. Full article

Aims: To explore the impact of the use of intracardiac echocardiography (ICE) in the ablation of supraventricular arrhythmias requiring transseptal catheterization (TSC), whilst analyzing the reduction in periprocedural complications and complications specifically related to TSC. Methods: A retrospective multicenter study collecting data from consecutive atrial fibrillation (AF) and supraventricular ablation procedures that required TSC was performed in five Italian centers. Based on physician discretion, TSC was performed with or without ICE. Periprocedural complications, separating all complications from complications directly related to TSC, were collected. Independent predictors of periprocedural complications and TSC-related complications were investigated. Results: A total of 2181 TSCs were performed on 1862 patients at five Italian centers from 2006 to 2021, in 76% of cases by AF ablation and in 24% by ablation of other arrhythmias with a circuit in the left atrium. Overall, 1134 (52%) procedures were performed with ICE support and 1047 (48%) without ICE. A total of 67 (3.1%) complications were detected, 19 (1.7%) in the ICE group and 48 (4.6%) in the no ICE group, p < 0.001. A total of 42 (1.5%) complications directly related to TSC: 0.9% in the ICE group and 3.1% in the no ICE group (p < 0.001). The independent predictors of all complications were age (OR 1,02 95% C.I 1.00–1.05; p = 0.036), TSC with the use of ICE (OR 0.27 95% C.I 0.15–0.46; p < 0.001) and AF ablation (OR 2,25 95%C.I 1.05–4.83; p = 0.037). The independent predictors for TSC complications were age (OR 1.03 95% C.I 1.01–1.06; p = 0.013) and TSC with the use of ICE (OR 0.24 95% C.I 0.11–0.49; p < 0.001). Conclusions: ICE reduced periprocedural and TSC-related complications during electrophysiological procedures for ablation of left atrial arrhythmias. Full article