Echocardiography in transseptal cardiac catheterization

Abstract

In selected patients, transseptal cardiac catheterization is the technique of choice for evaluation of left atrial and left ventricular anatomy and hemodynamics [1–3]. Although in many instances the measurement of left atrial pressure has been replaced by that of pulmonary wedge pressure, the latter is not always accurate and may be impossible to record (e.g. severe pulmonary hypertension). Left atrial catheterization is the reference standard for measuring left atrial pressure and mitral valve gradient and for approaching the left ventricle in an antegrade direction when the retrograde technique is difficult or hazardous. This situation may occur in patients with severe, calcific aortic stenosis or a prosthetic aortic valve. The technique is not used in every cardiac catheterization laboratory because of the need for special skill, experience and equipment. In the Cardiac Catheterization Laboratory of New York University Medical Center more than 3000 transseptal catheterizations were performed between 1969 and 1985. Table I summarizes the indications for transseptal catheterization. Table II summarizes the contraindications for such procedure. In experienced hands, complications are relatively rare. The most ominous complication is perforation of the intra-pericardial structures, which may lead to cardiac tamponade.KeywordsLeft AtriumRight AtriumInteratrial SeptumCardiac Catheterization LaboratoryPulmonary Wedge PressureThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.