An Unusual Complication of Transseptal Puncture

Abstract

The interatrial septum is a structure with complex embryological development. The true atrial septum is a circumscribed structure, and transgression outside of this area during transseptal puncture may result in entry into the extracardiac space or aorta that may result in a pericardial effusion or cardiac tamponade. (Level of Difficulty: Intermediate.).

Keywords: IAS, interatrial septum; SVC, superior vena cava; atrial fibrillation; complication; electrophysiology; pericardial effusion.

Graphical abstract

Figure 1

Transesophageal Echocardiography Bicaval View (Star) Interatrial septum hypertrophy. Sparing of the fossa ovalis (arrow).

Figure 2

Right and Left Anterior Oblique Projections of Wire Advancement Following Transseptal Puncture

Figure 3

Left Atrial Pressure Recording

Figure 4

Right Anterior Oblique Projection of Contrast Extravasation Into Transverse Pericardial Space and Simultaneous Contrast Flow Into the Left Ventricle

Figure 5

Left Anterior Oblique Projection of Contrast Extravasation Into Transverse Pericardial Space

Figure 6

Component Parts of the Definitive Atrial Septum IVC = inferior vena cava; SVC = superior vena cava.

Figure 7

4-Chamber Section Through the Heart Four-chamber section through the heart showing the offset arrangement of the mitral valve (MV) and tricuspid valve (TV) which produces the so-called muscular atrioventricular septum (∗) and the deep in folding (dotted lines) of the atrial wall superior and inferior to the floor of the oval fossa. IVC = inferior vena cava; SVC = superior vena cava.