Transseptal Puncture in Children Weighing Less Than 20 kg in Invasive Cardiac Catheterization and Electrophysiology

Transseptal puncture (TSP) is a widely utilized technique for left-sided electrophysiological studies (EPS), interventions in left heart lesions, or creating interatrial shunts in congenital heart diseases (CHD). This study aims to evaluate the outcome of TSP in children under 20 kg.

This retrospective study analyzed TSP procedures in infants and children <20 kg between December 2015 and January 2023. TSPs were performed with a biplane angiography system in the catheter angiography laboratory. A Brockenbrough needle (BRK Transseptal Needle; Abbott/St. Jude Medical, Inc.) was used for TSP. In patients whose Brockenbrough needles could not cross the interatrial septum, TSP was performed by applying cautery energy over the Brockenbrough needle.

Nineteen patients were studied (seven females, median age 2.3 years, median weight 10.3 kg), and 63% required TSP for CHD. The CHD group had younger patients (median age: 6.25 months) with smaller weights (median: 5.3 kg) than the catheter ablation group. There was no difference between groups in terms of gender and success rates. Procedure and fluoroscopy times were shorter in the ablation group (p < 0.05). Radiofrequency energy was used without complications in three cases when traditional methods failed. In four patients, the septum could not be traversed. The median weight of patients in whom TSP failed was 2.9 kg. The only major complication was pericardial tamponade developed in two patients diagnosed with hypoplastic left heart syndrome.

TSP is a safe option when carefully selected but carries higher risks in complex CHD with abnormal cardiac anatomy compared to patients with normal anatomy used for electrophysiology procedures.