Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1994 Mar;71(3):297–301. doi: 10.1136/hrt.71.3.297

Anterior staircase manoeuvre for atrial transseptal puncture.

T R Shaw 1
PMCID: PMC483670  PMID: 8142202

Abstract

OBJECTIVE--Assessment of an anterior staircase modification to the standard atrial transseptal technique. DESIGN--Retrospective report on patients undergoing atrial transseptal puncture. SETTING--A regional cardiac centre. PATIENTS--A series of 658 patients catheterised between 1975 and 1991. RESULTS--Needle entry to the left atrium was obtained in 647 (98.3%) patients with needle and catheter entry to the left atrial cavity in 637 patients (96.8%). Sustained atrial arrhythmia occurred in six patients (0.9%) and pronounced bradycardia in one. Cardiac perforation occurred in three patients (0.5%) but did not cause cardiac tamponade. There were no deaths or embolic complications caused by the transseptal puncture. The anterior staircase manoeuvre was particularly useful in patients with problem septa--that is, when the septum bulged into the right atrial cavity, lacked a detectable limbic edge, was tough or tender, or when the right atrium was considerably enlarged. CONCLUSION--The anterior staircase technique is a useful modification to the atrial transseptal puncture technique because it allows repeated passage down the atrial septum without the need for guidewire and needle exchanges for repositioning in the superior vena cava.

Full text

PDF
297

Images in this article

298Image
on p.298
299Image
on p.299

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BLOOMFIELD D. A., SINCLAIR-SMITH B. C. THE LIMBIC LEDGE. A LANDMARK FOR TRANSSEPTAL LEFT HEART CATHETERIZATION. Circulation. 1965 Jan;31:103–107. doi: 10.1161/01.cir.31.1.103. [DOI] [PubMed] [Google Scholar]
  2. BROCKENBROUGH E. C., BRAUNWALD E., ROSS J., Jr Transseptal left heart catheterization. A review of 450 studies and description of an improved technic. Circulation. 1962 Jan;25:15–21. doi: 10.1161/01.cir.25.1.15. [DOI] [PubMed] [Google Scholar]
  3. Conti C. R., Ross R. S. The risks of cardiac catheterization. Am Heart J. 1969 Sep;78(3):289–291. doi: 10.1016/0002-8703(69)90036-2. [DOI] [PubMed] [Google Scholar]
  4. Doorey A. J., Goldenberg E. M. Transseptal catheterization in adults: enhanced efficacy and safety by low-volume operators using a "non-standard" technique. Cathet Cardiovasc Diagn. 1991 Apr;22(4):239–243. doi: 10.1002/ccd.1810220402. [DOI] [PubMed] [Google Scholar]
  5. Dunn M. Is transseptal catheterization necessary? J Am Coll Cardiol. 1985 Jun;5(6):1393–1394. doi: 10.1016/s0735-1097(85)80354-5. [DOI] [PubMed] [Google Scholar]
  6. Enghoff E., Cullhed I. Experiences with transseptal left heart catheterization. A review of 454 studies. Am Heart J. 1971 Mar;81(3):398–408. doi: 10.1016/0002-8703(71)90111-6. [DOI] [PubMed] [Google Scholar]
  7. Inoue K. Percutaneous transvenous mitral commissurotomy using the Inoue balloon. Eur Heart J. 1991 Jul;12 (Suppl B):99–108. doi: 10.1093/eurheartj/12.suppl_b.99. [DOI] [PubMed] [Google Scholar]
  8. PARKER J. O., WEST R. O., FAY J. E. THE BROCKENBROUGH TRANSSEPTAL CATHETERIZATION: AN UNUSUAL COMPLICATION. Circulation. 1964 Nov;30:743–744. doi: 10.1161/01.cir.30.5.743. [DOI] [PubMed] [Google Scholar]
  9. ROSS J., Jr, BRAUNWALD E., MORROW A. G. Transseptal left atrial puncture; new technique for the measurement of left atrial pressure in man. Am J Cardiol. 1959 May;3(5):653–655. doi: 10.1016/0002-9149(59)90347-9. [DOI] [PubMed] [Google Scholar]
  10. ROSS J., Jr Transeptal left heart catheterization: a new method of left atrial puncture. Ann Surg. 1959 Mar;149(3):395–401. doi: 10.1097/00000658-195903000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ross J., Jr Considerations regarding the technique for transseptal left heart catheterization. Circulation. 1966 Sep;34(3):391–399. doi: 10.1161/01.cir.34.3.391. [DOI] [PubMed] [Google Scholar]
  12. Schoonmaker F. W., Vijay N. K., Jantz R. D. Left atrial and ventricular transseptal catheterization review: losing skills? Cathet Cardiovasc Diagn. 1987 Jul-Aug;13(4):233–238. doi: 10.1002/ccd.1810130403. [DOI] [PubMed] [Google Scholar]
  13. Wyman R. M., Safian R. D., Portway V., Skillman J. J., McKay R. G., Baim D. S. Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol. 1988 Dec;12(6):1400–1406. doi: 10.1016/s0735-1097(88)80002-0. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES