[Transseptal catheterization: technique and complications]

Transseptal puncture was first described by Ross and Cope, independently, in 1959. This technique was developed predominantly for the diagnostic evaluation of valvular heart disease. After a few years, transseptal catheterization has been replaced by indirect measurements of left atrial pressure using the Swan-Ganz catheter. Recently, there has been a renewed interest in transseptal puncture because of emerging therapeutic procedures for structural heart disease and atrial fibrillation ablation. Current transseptal technique has changed very little since the initial reports, but new tools are now available to facilitate transseptal puncture including echocardiographic imaging (three-dimensional, transesophageal, or intracardiac), radiofrequency powered wires and needle-tipped guidewires. Transseptal catheterization can be performed with high success rates and low complication rates. An Italian survey reported a success rate of 99% with a complication rate of 0.76%. Complications included aortic perforation, pericardial tamponade, ST-segment elevation, cerebral air embolization, systemic embolization, and thrombus formation on the transseptal sheath.