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European Heart Journal Advance Access originally published online on October 17, 2005
European Heart Journal 2006 27(11):1330; doi:10.1093/eurheartj/ehi541
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Trans-septal route may be hazardous

Luc De Roy, Dominique Blommaert and Frédéric Deprez*

Cliniques Universitaires UCL de Mont Godinne, Service de Cardiologie, Av. Thérasse 1, Yvoir 5530, Belgium

* Corresponding author. E-mail address: deroy{at}card.ucl.ac.be

Trans-septal approach has to be performed by trained cardiologists, and even after the obligatory learning curve it entails some risky complications. Sometimes the dilator and the introducer sheat passes through a narrow foramen ovale and glides into the left atrium without needle puncture. This seems to be a convenient and harmless way to push the introducer into the left atrium, avoiding the risk of puncturing structures outside the atrium.

By doing so, we experienced two times a passage of the trans-septal introducer set between the leaflets of the ostium primum and secundum into the septal and anterior wall of the left atrium causing partial dissection and haematoma just behind the aortic wall. Fluoroscopy showed a clear left-oriented course of the introducer. However, the disappearance of the pressure curve and the impression of a stucked introducer precluded to push it further (Panels A and B).

A transoesophageal echocardiogram showed a localized haematoma in the anterior atrial wall, just behind the aortic posterior wall (Panels C–F). The evolution was uneventful except for short-lasting thoracic pain.

These cases illustrate the need for careful monitoring of pressure during the trans-septal procedure and the importance of performing always a classical trans-septal puncture and not to try to create a passage through a supposed open foramen ovale by forcing a catheter or an introducer into it.

Panels A and B. Dye injection in the atrial septum through the introducer.

Panels C–F. Left atrial-aortic junction before and after dissection: TEE 141–121° and TEE 58–46°.

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
27/11/1330    most recent
ehi541v1
Right arrow E-letters: Submit a response
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Right arrow Articles by De Roy, L.
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