Transseptal access for left heart structural interventions in the setting of prior atrial septal defect closure

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...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2020-02, Vol.95 (3), p.414-419
Main Authors: Yap, Jonathan, Chen, Sarah, Stripe, Benjamin R., Smith, Thomas W. R., Rogers, Jason H., Singh, Gagan D.
Format: Article
Language:English
Subjects:
ASD/PDA/PFO
catheterization
closure
Heart
Literature reviews
Septum
structural heart disease intervention
transseptal
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Summary: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.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.28548