Breaking the Barriers: Transseptal Puncture in Patients with Atrial Septal Defect Closure Devices

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Atrial septal defects and patent foramen ovale are prevalent congenital heart defects in adults.
• Atrial septal occluders (ASOs) are commonly used for percutaneous closure of these defects.

Purpose of the Study:

• To review techniques, applications, and strategies for transseptal puncture (TSP) in patients with ASOs during left atrial interventions.
• To highlight the challenges and solutions associated with TSP in this patient population.

Main Methods:

• Review of existing literature on TSP techniques and ASO management.
• Discussion of pre-procedural planning using transoesophageal echocardiography and cardiac CT.
• Description of advanced techniques like balloon-assisted tracking and radiofrequency energy delivery.

Main Results:

• TSP in patients with ASOs presents unique procedural challenges.
• Optimal puncture sites can be identified through native septum or across the ASO using advanced imaging.
• Specialized expertise and multimodality imaging are crucial for successful outcomes.

Conclusions:

• TSP is a critical procedure for various left atrial interventions, including pulmonary vein isolation and left atrial appendage occlusion.
• Careful planning and advanced techniques can overcome challenges associated with ASOs.
• Minimizing complications such as residual shunting and device deformation requires specialized skills.