ABSTRACT
Transseptal left heart catheterization Transseptal catheterization, which allows access to the left atrium, is the first step of several interventional procedures and one of the most crucial. Transseptal left heart catheterization was introduced independently in 1959 by Ross and Cope, and later modified by Brockenbrough and Mullins.1-4
The procedure was introduced as an alternative to the methods available at that time, such as directly measuring left atrial and left ventricular pressures using either the transbronchial or transthoracic approaches.5 The developments of the flotation pulmonary artery catheter in 1970 by Swan and Ganz6 and retrograde cardiac catheterization of the left ventricle led to a significant decline in utilization of the transseptal technique. Furthermore, with fewer patients with valvular disease and improved echocardiography, a smaller number of cardiologists were trained to perform the procedure.7,8 With fewer procedures came fewer qualified personnel, and, because of concern over potentially grave complications and associated mortality, the procedure attained an ‘aura of danger and intrigue’.9 With the introduction of interventional procedures such as percutaneous mitral valvuloplasty, antegrade percutaneous aortic valvuloplasty, and now radiofrequency ablation of left-sided bypass tracts, there has been an increased demand for, and rekindled interest in, transseptal catheterization.10,11 We will describe the technique, indications, and complications of transseptal left heart catheterization.
