18-year experience with transseptal procedures through baffles, conduits, and other intra-atrial patches

The presence of an intra-atrial patch (IAP) has been considered a relative contraindication to transseptal puncture (TSP). The purpose of this study i s to determine the efficacy and safety of the TSP through baffles, conduits , pericardial patches and other prosthetic materials in the intra-atrial se ptum. We reviewed the records of all pediatric patients with IAP who underw ent TSP at Texas Children's Hospital from November 1979 through February 19 98. The review included the cardiac diagnoses, indications for TSP, technic al difficulties and follow up echocardiograms specifically addressing resid ual atrial shunts A total of 1958 TSP were performed. Thirty-nine patients had IAP, Cardiac diagnoses In those 39 patients included D-transposition of the great arteries after Mustard (10) or Senning procedure (6), single ven tricle variant post-Fontan operation (4), total anomalous venous return rep air (4), atrioventricular canal repair (9) and atrial septal defect with pa tch repair (6). Patients' age ranged from 1-31 years (median 7 years). The duration from the time of surgical repair to TSP ranged from 0.1-21 years ( median 5 years). Indications for TSP included diagnostic and therapeutic in tervention for pulmonary venous obstruction (12), creation of a baffle fene stration (2), prosthetic mitral valve evaluation (1), left ventricular outf low tract evaluation (1), access the left heart for hemodynamic evaluation (23). The IAP was traversed in 38/39 patients (97.5%), followed by diagnost ic or therapeutic prograde left-heart catheterization. No complications wer e encountered. Follow up echocardiography in 30/38 PTS demonstrated no resi dual shunting across the atrial septum except for two cases in which the at rial baffle had been intentionally fenestrated. Transseptal puncture throug h an intra-atrial patch is a safe procedure. This technique is effective in permitting diagnostic and therapeutic left heart catheterization and does not result in residual shunting through the patch. Cathet Cardiovasc. Inter vent 50:434-439, 2000. (C) 2000 Wiley-Liss. Inc.