Transseptal puncture using surgical electrocautery in children and adults with and without complex congenital heart
Srinath T Gowda1,2, Athar M Qureshi3, Daniel Turner2
1Pediatric Cardiology, The Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas.
Insights
Radiofrequency (RF) current via surgical electrocautery needle offers a safe and effective method for transseptal puncture (TSP) in complex congenital heart disease (CHD). This technique facilitates diagnostic, interventional, and electrophysiology procedures in challenging pediatric and adult cases.
Area of Science:
- Cardiovascular Medicine
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Transseptal puncture (TSP) is a critical but challenging procedure for cardiac catheterization, especially in patients with complex congenital heart disease (CHD).
- Existing methods for TSP can be difficult in pediatric and adult patients with intricate cardiac anatomies.
Purpose of the Study:
- To evaluate the efficacy and safety of using radiofrequency (RF) current delivered via a surgical electrocautery needle for performing TSP.
- To assess the utility of this technique in facilitating various diagnostic and interventional cardiac catheterization procedures.
Main Methods:
- A retrospective review of 55 TSP procedures using RF energy (10-25 W) via surgical electrocautery across three centers from January 2011 to January 2017.
- Echocardiograms were used to classify atrial septum characteristics as normal or complex (e.g., thin, aneurysmal, fibrotic, patched, or involving conduits).
Main Results:
- The study included 54 patients (median age 12.5 years) with diverse indications, including electrophysiology studies, ablations, diagnostic catheterizations, and interventional procedures.
- TSP was successful in 98% (54/55) of cases, with minor pericardial effusions in two patients not requiring intervention.
- One critically ill neonate with complex CHD experienced an unsuccessful TSP resulting in cardiac arrest, necessitating CPR, ECMO, and surgery.
Conclusions:
- Radiofrequency current delivery using surgical electrocautery for TSP is a feasible and effective approach.
- This technique is particularly valuable for diagnostic, interventional, and electrophysiology procedures in patients with complex CHD.
- The RF current method provides a reliable option for challenging transseptal punctures.
Background:
Atrial transseptal puncture (TSP) for cardiac catheterization procedures remain challenging in children and adults with complex congenital heart disease (CHD).
Objectives:
We sought to evaluate our experience using radiofrequency (RF) current via surgical electrocautery needle for TSP to facilitate diagnostic and interventional procedures.
Methods:
Retrospective chart review of all patients (pts) who underwent TSP using RF energy (10-25 W) via surgical electrocautery from three centers from January 2011 to January 2017 were evaluated. Echocardiograms were reviewed to define the atrial septum as normal and complex (thin aneurysmal, thick/fibrotic, synthetic patch material, and extra cardiac conduit).
Results:
A total of 54 pts underwent 55 successful TSP. Median age was 12.5 years (1 day-54 years) and weight was 52.7 kg (2-162). Indications for TSP included; EP study and ablation procedures in structurally normal hearts (n = 24) and in complex atrial septum/CHD and structural heart disease pts (n = 30): Electrophysiology study and ablation in 4, diagnostic catheterization in 9, and interventional procedures in 17 pts were performed. Atrial TSP was successful in 54/55 (98%). Atrial perforation with tiny-small pericardial effusion not requiring intervention was noted in 2 pts. TSP was unsuccessful in one critically ill neonate with unobstructed TAPVR and restricted atrial septum who experienced cardiac arrest requiring CPR, ECMO, and emergent surgery.
Conclusions:
RF current delivery using surgical electrocautery for TSP is a feasible and an effective option in patients with complex CHD for diagnostic, interventional, and electrophysiology procedures.
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