Stainless steel transseptal needle and stylet 1 unit per box brk transseptal needles, xs series product highlights bevel angle 30 degrees steeper primary bevel angle and two back bevels that combine to form a distinct point at the tip of the needle pointer on the needle shield shows the direction of the needle curve reorder. The use of a steerable sheath with a long transseptal needle is a safe and effective alternative for transseptal puncture once superior access has been determined. Transseptal puncture tsp is now widely used in interventional cardiology. Each safesept needle free transseptal guidewire system kit includes. We compared safety and efficacy of a modified tsp technique mosquito technique, mosqtsp to conventional tsp convtsp. In contrast to other cutdown techniques see chapter 8, the percutaneous approach to left and right heart catheterization uses a needle puncture to achieve vascular access1 and. The search was performed in pubmed, scopus and isi web of knowledge using the expression transseptal puncture.
The location of the puncture determines the maneuverability of the mitraclip guide and the clip delivery system cds. The transseptal puncture is safe, but not 100% overall, serious complications from transseptal catheterization are may 15, 2017 how to perform transseptal puncture 1. Clinical studies have demonstrated the value of rf transseptal needle technology. Although the use of the sheath may vary, the ability to precisely control the distal end of the sheath during the atrial septal puncture is a common requirement. A very small distance from the interatrial septum to the left atrial free wall was seen. Brockenbrough needle to puncture the interatrial septum in the region of the fossa ovalis. Inadvertent puncture of the aortic root ar is a wellknown complication of transseptal puncture tsp.
Transseptal techniques for emerging structural heart. Various imaging modalities such as intracardiac echocardiography have been reported and may be. Transseptal access and atrial fibrillation ablation guided. Successful transseptal puncture and cryoballoon ablation. Transseptal techniques for emerging structural heart interventions. The cryoballoon technique can be considered as an alternative to pulmonary vein isolation due to the right jugular vein approach. Transseptal catheterization and interventions 2010 pdf. Deliver a continuous heparinized solution infusion or aspirate periodically. The transseptal puncture is safe, but not 100% overall, serious complications from transseptal catheterization are transseptal needle to facilitate septal puncture,6 as well as the use of laser energy to achieve the same 7 also, enhanced visualization of the transseptal puncture using intracardiac echocardiography ice,8 realtime computed tomography imaging,9 threedimensional 3d electroanatomic. The very sharp tip of the safesept nf requires 85% less force than a conven tional transseptal needle and easily perforates and crosses the fossa. The typical mechanism of injury is misdirected transseptal puncture performed too posteriorly and subsequent catheter exit.
This product line is serviced by the following clinical division s. Jun 20, 2016 rfassisted transseptal puncture has been initially described as bailout of conventional transseptal needle puncture. Rfassisted transseptal puncture has been initially described as bailout of conventional transseptal needle puncture. Peripheral intervention interested in ordering this product. Successful transseptal puncture and cryoballoon ablation of.
This is a pdf file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet. If transseptal puncture is required, refer to the instructions for use of the transseptal puncture device. However, a rightside venous femoral puncture is usually preferred for the tp procedure due to the more. Transseptal catheterization using electrophysiological landmarks. Many surgical procedures involve creating a puncture in the fossa ovalis to allow for passage of diagnostic and therapeutic tools to the left heart. Transseptal solutions advanced steerable transseptal.
Holmes, jr,md abstract the development of new transseptal transcatheter interventions for patients with structural heart disease is fueling increasing interest in transseptal puncture techniques. One tip straightener dispenser five 5 kits per box product description the safesept needle free transseptal guidewire, when used in conjunction with a transseptal dilator and introducer, creates the primary puncture in the interatrial septum, without the need for a. However, there are a limited number of articles published concerning transseptal puncture without the use of fluoroscopy. Pdf novel solutions applied in transseptal puncture. Transseptal puncture at the anterior inferior part of fossa ovalis fo was preferred for antegrade approach of left ventricular ventricular tachycardia vt ablation. Direct hepatic vein puncture and transseptal access for. Safesept needle free transseptal guidewire transseptal access. Transseptal catheterisation was introduced in the late 50s1 and gained popularity with the introduction of the electrophysiological and structural heart interventions. In the absence of a direct randomized comparison of the double transseptal puncture technique versus the single transseptal puncture access for the ablation of af, limited conclusions regarding superiority of one technique over the other in terms of safety and procedural outcome can be made.
Due to coronary anatomy, the left atrium is difficult to access for interventional treatment. The nrg transseptal needle uses a blunttipped electrode to deliver a short and highly focused rf energy pulse, allowing a reliable, controlled puncture without needing to push through the septum using a sharp, mechanical needle. It is performed under transesophageal echocardiographic guidance because precise localization of the puncture site is crucial for the rest of the procedure. The transseptal dilator is loaded with a brockenbrough needle that is advanced to within 2 to 4 cm of the dilator tip. Utilizing 3d navx for transseptal puncture as an additional. Modified transseptal puncture technique in challenging septa. Percutaneous approach, including transseptal and apical puncture. Pdf intracardiac echocardiography for transseptal puncture. The module provides practice for left atrial access via the intraatrial septum fossa ovalis using a correct and safe puncture technique, under fluoroscopic and echocardiographic guidance. Learning process for transseptal puncture guided by intracardiac. Presented in this paper is the first series of patients n 10 that have undergone transseptal puncture without the use of fluoroscopy under transesophageal echocardiography control using a radiofrequency transseptal needle and a 3d navigation system.
This exposes patients and healthcare professionals to deleterious ionizing radiation. Double transseptal puncture for catheter ablation of. Transseptal puncture is the technique of creating a small surgical passage through the atrial septum wall between the right and left atrium through which a catheter can be directly fed. Safe and reproducibly effective transseptal puncture and access to the left atrium and ventricle is now a prerequisite for the practicing invasive electrophysiologist. Chapter 4 transseptal heart catheterization khung keong yeo, jason h. The training and learning process of transseptal puncture using a modified technique article pdf available in europace 1512 august 20 with 245 reads how we measure reads. During the simulation, life threatening complications such as pericardial effusion or aortic puncture will need to be attended to. Intracardiac echocardiography showed a small oval fossa abouting to an enlarged aorta anteriorly. Inadvertent transseptal puncture into the aortic root. The latter two conditions were predisposing to a complicated transseptal puncture. The transseptal puncture process has been associated with serious complications such as cardiac tamponade, requiring medical intervention and prolonging hospital stay. Is there a cpt code for transseptal access to ablate lateral pathway.
The use of transoesophageal or intracardiac echocardiography facilitates catheter guidance and proper needle positioning during transseptal puncture in similar cases. Transseptal techniques for emerging structural heart interventions mohamad alkhouli, md, charanjit s. Transseptal puncture has been historically performed by pushing a sharp, mechanical needle across the interatrial septum. Transseptal puncture for structural heart intervention. Additional access to the right internal jugular vein was obtained using a second short 6f sheath, which was replaced by an 8. Direct hepatic vein puncture and transseptal access for atrial flutter and fibrillation ablation in a patient with prior ligation of the inferior vena cava. Since the development of radiofrequency catheter ablation for the treatment of atrial fibrillation, electrophysiology laboratories have. Vein puncture and transseptal access for atrial flutter and fibrillation ablation in a patient with prior. Recent advances in cardiac electrophysiology and left heart interventions have led to renewed interest in the technique as a means of delivering modern therapeutic interventions. The results showed that the septum was successfully crossed in all patients receiving transseptal puncture with the rf needle, whereas 438 patients 11% in the mechanical needle. Rf transseptal puncture nrg rf transseptal needle quick reference guide. Percutaneous approach, including transseptal and apical puncture claudia a. The transseptal sheath and dilator are ad vanced over a guidewire into the superior vena cava and often placed in the proximal portion of the left subclavian vein.
Strategies for handling of this potentially lethal complication have not been identified yet. This is the first case series focusing on the different sites of puncture with an rf needle based on the type of procedure. Modified transseptal puncture technique in challenging. The fossa ovalis is a small, hardtofind depression in the right atrium. Atrial fibrillation atrial flutter performing common cardiac procedures such as. How to perform transseptal puncture alireza ghorbani sharif, md electrophysiologist tehran arrhythmia clinic sep 2016 2.
In this study, we present typical anatomical locations and clinical management of aortic root puncture arp due to tsp. Safesept needle free transseptal guidewire transseptal. When areas of native septum were not available for transseptal access, a direct puncture of the closure device was performed. Transseptal catheterization requires the use of the. Intracardiac echocardiography ice is an attractive tool. A novel technique for performing transseptal puncture guided. Utilizing 3d navx for transseptal puncture as an additional safeguard. The training and learning process of transseptal puncture.
The development of new transseptal transcatheter interventions for patients with structural heart disease is. Transseptal catheterization through the atrial septum has become a useful skill for electrophysiologists. We describe a novel technique for performing tsp non. Transseptal techniques for emergingstructural heart interventions.
In the absence of a direct randomized comparison of the double transseptal puncture technique versus the single transseptal puncture access for the ablation of af, limited conclusions regarding superiority of one technique over the other in. Used for transseptal leftheart access in both diagnostic and interventional procedures. Femoral puncture both groins should be prepared because invasive arterial monitoring might be needed should any complication occur. A novel technique for performing transseptal puncture. Unsupported by the dilator and sheath, the tip of the guidewire assumes a j shape. The challenge for a successful transseptal puncture is. This technique may result in lifethreatening complications at times. In this case, a direct left atrial access with the transseptal sheath was not possible due to a high resis tance encountered by the external sheath 10fr in crossing the device. Transseptal puncture transseptal puncture is a wellknown and widelyused procedure, providing percutaneous access to the left atrium of the heart. Percutaneous approach, including transseptal and apical. This is a pdf file of an article that has undergone. The development of new transseptal transcatheter interventions for patients with structural heart disease is fueling increasing interest in transseptal puncture techniques. Knowledge of interatrial septum anatomy, appropriate equipment, and proper technique are key to successful transseptal puncture.
Transseptal access cardiology coding ask an expert. Double transseptal puncture for catheter ablation of atrial. The key to a successful catheterization of the left heart chambers is the safe transseptal puncture. Cardiac tamponade is the most common life threatening complication of transseptal puncture and the incidence is approximately 1 per 100 cases,, although others report significantly lower rates. Transeptal access is an integral skill for interventional cardiologists for a multitude of cardiac interventions including, balloon mitral valvotomy a. Transseptal puncture in situs inversus totalis using a. Proper location of the puncture site on septum is the first and also the most critical step during tsp. Intracardiac echocardiography ice is an attractive tool used in cardiac catheterization and. The transseptal puncture tp technique was introduced into clinical practice during. Monitor the location of the radiopaque tip frequently under fluoroscopy. The transseptal puncture is a critical part of the mitraclip procedure. Designed to make transseptal access easier, especially in difficult or even previously failed cases, improving the safety of whatever introducer system you are currently using, while requiring less force than a standard transseptal needle to cross the interatrial septum.
Transseptal access is commonly performed for any procedure that requires access to the left side of the heart such as catheter ablation of atrial fibrillation, left atrial tachycardia, leftsided accessory pathways, ventricular tachycardia, left atrial appendage closure, percutaneous mitral valvuloplasty, and mitral valve repair. Preventing complicated transseptal puncture with intracardiac. Although the transseptal technique was described half a century ago, it has remained essentially unchanged. Different transseptal puncture for different procedures. Transseptal puncture tsp is commonly performed under fluoroscopic guidance in left atrial ablation procedures.
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