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A Novel Deep Inspiration Maneuver for Difficult Transseptal Puncture

Transseptal puncture (TSP) may not be possible in cases of an elastic, aneurysmal, or thickened interatrial septum (IAS). During deep inspiration (DI), the chest wall expands and the diaphragm descends. This makes intrapleural pressure to become more negative, which leads to movement of the IAS to t... Full description

Journal Title: The American journal of cardiology 2016, Vol.119 (3), p.428-433
Main Author: Aksu, Tolga, MD, FESC
Other Authors: Guler, Tumer Erdem, MD , Yalin, Kivanc, MD , Golcuk, Sukriye Ebru, MD , Ozcan, Kazim Serhan, MD , Guler, Niyazi, MD
Format: Electronic Article Electronic Article
Language: English
Subjects:
Age
Publisher: United States: Elsevier Inc
ID: ISSN: 0002-9149
Link: https://www.ncbi.nlm.nih.gov/pubmed/27884419
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title: A Novel Deep Inspiration Maneuver for Difficult Transseptal Puncture
format: Article
creator:
  • Aksu, Tolga, MD, FESC
  • Guler, Tumer Erdem, MD
  • Yalin, Kivanc, MD
  • Golcuk, Sukriye Ebru, MD
  • Ozcan, Kazim Serhan, MD
  • Guler, Niyazi, MD
subjects:
  • Abridged Index Medicus
  • Accessory Atrioventricular Bundle - surgery
  • Adult
  • Age
  • Aged
  • Aneurysms
  • Atrial Fibrillation - surgery
  • Atrial Septum - surgery
  • Cardiac arrhythmia
  • Cardiac Catheterization - methods
  • Cardiology
  • Cardiovascular
  • Catheter Ablation - methods
  • Catheters
  • Cohort Studies
  • Echocardiography, Transesophageal
  • Feasibility Studies
  • Female
  • Heart Atria
  • Humans
  • Inhalation
  • Localization
  • Male
  • Middle Aged
  • Mitral Valve Annuloplasty - methods
  • Mitral Valve Stenosis - surgery
  • Patients
  • Postoperative Complications
  • Prospective Studies
  • Punctures - methods
  • Veins & arteries
ispartof: The American journal of cardiology, 2016, Vol.119 (3), p.428-433
description: Transseptal puncture (TSP) may not be possible in cases of an elastic, aneurysmal, or thickened interatrial septum (IAS). During deep inspiration (DI), the chest wall expands and the diaphragm descends. This makes intrapleural pressure to become more negative, which leads to movement of the IAS to the right side. The aim of this study was to verify prospectively the feasibility, safety, and outcome of DI associated with conventional TSP technique in patients with challenging IAS anatomy. From September 2012 to May 2016, 224 patients underwent TSP due to different indications. Patients were divided into 2 groups: 213 patients in whom the left atrium was successfully accessed in 3 attempts were grouped as conventional TSP group and 11 patients in whom left atrium access was failed after 3 conventional attempts were grouped as DI-TSP group. Conventional TSP was successful in 89.6% of patients with the first attempt. Second and third attempts were required in 4.1% and 1.4%, respectively. Septal puncture was achieved at the first attempt in 10 patients within a median of 1 second of DI maneuver (interquartile range, 1 to 3) and without any complications. Challenging IAS anatomy consisting of IAS aneurysm, a thick IAS, and an excessively mobile IAS were more frequent in the DI-TSP group (45% to 8%, 27% to 3%, and 21% to 5%, respectively, p
language: eng
source:
identifier: ISSN: 0002-9149
fulltext: no_fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titleA Novel Deep Inspiration Maneuver for Difficult Transseptal Puncture
creatorAksu, Tolga, MD, FESC ; Guler, Tumer Erdem, MD ; Yalin, Kivanc, MD ; Golcuk, Sukriye Ebru, MD ; Ozcan, Kazim Serhan, MD ; Guler, Niyazi, MD
creatorcontribAksu, Tolga, MD, FESC ; Guler, Tumer Erdem, MD ; Yalin, Kivanc, MD ; Golcuk, Sukriye Ebru, MD ; Ozcan, Kazim Serhan, MD ; Guler, Niyazi, MD
descriptionTransseptal puncture (TSP) may not be possible in cases of an elastic, aneurysmal, or thickened interatrial septum (IAS). During deep inspiration (DI), the chest wall expands and the diaphragm descends. This makes intrapleural pressure to become more negative, which leads to movement of the IAS to the right side. The aim of this study was to verify prospectively the feasibility, safety, and outcome of DI associated with conventional TSP technique in patients with challenging IAS anatomy. From September 2012 to May 2016, 224 patients underwent TSP due to different indications. Patients were divided into 2 groups: 213 patients in whom the left atrium was successfully accessed in 3 attempts were grouped as conventional TSP group and 11 patients in whom left atrium access was failed after 3 conventional attempts were grouped as DI-TSP group. Conventional TSP was successful in 89.6% of patients with the first attempt. Second and third attempts were required in 4.1% and 1.4%, respectively. Septal puncture was achieved at the first attempt in 10 patients within a median of 1 second of DI maneuver (interquartile range, 1 to 3) and without any complications. Challenging IAS anatomy consisting of IAS aneurysm, a thick IAS, and an excessively mobile IAS were more frequent in the DI-TSP group (45% to 8%, 27% to 3%, and 21% to 5%, respectively, p <0.001). In conclusion, TSP by using the DI maneuver may be a reliable and safe method after failed conventional attempts. If there is any doubt about the correct location of the needle, additional imaging modalities have to be used.
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subjectAbridged Index Medicus ; Accessory Atrioventricular Bundle - surgery ; Adult ; Age ; Aged ; Aneurysms ; Atrial Fibrillation - surgery ; Atrial Septum - surgery ; Cardiac arrhythmia ; Cardiac Catheterization - methods ; Cardiology ; Cardiovascular ; Catheter Ablation - methods ; Catheters ; Cohort Studies ; Echocardiography, Transesophageal ; Feasibility Studies ; Female ; Heart Atria ; Humans ; Inhalation ; Localization ; Male ; Middle Aged ; Mitral Valve Annuloplasty - methods ; Mitral Valve Stenosis - surgery ; Patients ; Postoperative Complications ; Prospective Studies ; Punctures - methods ; Veins & arteries
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descriptionTransseptal puncture (TSP) may not be possible in cases of an elastic, aneurysmal, or thickened interatrial septum (IAS). During deep inspiration (DI), the chest wall expands and the diaphragm descends. This makes intrapleural pressure to become more negative, which leads to movement of the IAS to the right side. The aim of this study was to verify prospectively the feasibility, safety, and outcome of DI associated with conventional TSP technique in patients with challenging IAS anatomy. From September 2012 to May 2016, 224 patients underwent TSP due to different indications. Patients were divided into 2 groups: 213 patients in whom the left atrium was successfully accessed in 3 attempts were grouped as conventional TSP group and 11 patients in whom left atrium access was failed after 3 conventional attempts were grouped as DI-TSP group. Conventional TSP was successful in 89.6% of patients with the first attempt. Second and third attempts were required in 4.1% and 1.4%, respectively. Septal puncture was achieved at the first attempt in 10 patients within a median of 1 second of DI maneuver (interquartile range, 1 to 3) and without any complications. Challenging IAS anatomy consisting of IAS aneurysm, a thick IAS, and an excessively mobile IAS were more frequent in the DI-TSP group (45% to 8%, 27% to 3%, and 21% to 5%, respectively, p <0.001). In conclusion, TSP by using the DI maneuver may be a reliable and safe method after failed conventional attempts. If there is any doubt about the correct location of the needle, additional imaging modalities have to be used.
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1Accessory Atrioventricular Bundle - surgery
2Adult
3Age
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5Aneurysms
6Atrial Fibrillation - surgery
7Atrial Septum - surgery
8Cardiac arrhythmia
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15Echocardiography, Transesophageal
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18Heart Atria
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21Localization
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23Middle Aged
24Mitral Valve Annuloplasty - methods
25Mitral Valve Stenosis - surgery
26Patients
27Postoperative Complications
28Prospective Studies
29Punctures - methods
30Veins & arteries
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authorAksu, Tolga, MD, FESC ; Guler, Tumer Erdem, MD ; Yalin, Kivanc, MD ; Golcuk, Sukriye Ebru, MD ; Ozcan, Kazim Serhan, MD ; Guler, Niyazi, MD
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abstractTransseptal puncture (TSP) may not be possible in cases of an elastic, aneurysmal, or thickened interatrial septum (IAS). During deep inspiration (DI), the chest wall expands and the diaphragm descends. This makes intrapleural pressure to become more negative, which leads to movement of the IAS to the right side. The aim of this study was to verify prospectively the feasibility, safety, and outcome of DI associated with conventional TSP technique in patients with challenging IAS anatomy. From September 2012 to May 2016, 224 patients underwent TSP due to different indications. Patients were divided into 2 groups: 213 patients in whom the left atrium was successfully accessed in 3 attempts were grouped as conventional TSP group and 11 patients in whom left atrium access was failed after 3 conventional attempts were grouped as DI-TSP group. Conventional TSP was successful in 89.6% of patients with the first attempt. Second and third attempts were required in 4.1% and 1.4%, respectively. Septal puncture was achieved at the first attempt in 10 patients within a median of 1 second of DI maneuver (interquartile range, 1 to 3) and without any complications. Challenging IAS anatomy consisting of IAS aneurysm, a thick IAS, and an excessively mobile IAS were more frequent in the DI-TSP group (45% to 8%, 27% to 3%, and 21% to 5%, respectively, p <0.001). In conclusion, TSP by using the DI maneuver may be a reliable and safe method after failed conventional attempts. If there is any doubt about the correct location of the needle, additional imaging modalities have to be used.
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pmid27884419
doi10.1016/j.amjcard.2016.10.023
orcididhttps://orcid.org/0000-0001-8061-9660