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J Am Coll Cardiol, 2008; 51:2116-2122, doi:10.1016/j.jacc.2008.01.061
© 2008 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Emerging Applications for Transseptal Left Heart Catheterization

Old Techniques for New Procedures

Vasilis C. Babaliaros, MD*, Jacob T. Green, MD, Stamatios Lerakis, MD, FACC, Michael Lloyd, MD and Peter C. Block, MD, FACC

Andreas Gruentzig Cardiovascular Center, Emory University Hospital, Atlanta, Georgia.

Manuscript received December 7, 2007; revised manuscript received January 15, 2008, accepted January 24, 2008.

* Reprint requests and correspondence: Dr. Vasilis Babaliaros, Department of Cardiology, Emory University Hospital, 1364 Clifton Road, Suite F606, Atlanta, Georgia 30322. (Email: Vasilis.babaliaros{at}emoryhealthcare.org).

Transseptal (TS) catheterization was introduced in 1959 as a strategy to directly measure left atrial (LA) pressure. Despite acceptable feasibility and safety, TS catheterization has been replaced by indirect measurements of LA pressure using the Swan-Ganz catheter. Today, TS puncture is rarely performed for diagnostic purposes but continues to be performed for procedures such as balloon mitral valvuloplasty, antegrade balloon aortic valvuloplasty, and ablation of arrhythmias in the LA. Thus, the "art" of TS puncture has been lost, except in centers that perform these procedures with regularity. Recently, there has been a renewed interest in the TS technique because of emerging therapeutic procedures for structural heart disease and atrial fibrillation ablation. Invasive cardiologists will have to refamiliarize themselves with the TS technique, newer TS devices, and advanced ultrasound imaging for guidance of the procedure.

Abbreviations and Acronyms
  ASD = atrial septal defect
  EP = electrophysiology
  LA = left atrial/atrium
  PFO = patent foramen ovale
  PVL = paravalvular leak
  RA = right atrium/atrial
  RF = radiofrequency
  TEE = transesophageal echocardiography
  TS = transseptal
  TTE = transthoracic echocardiography




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