Left atrial and ventricular transseptal catheterization review: losing skills?

Transseptal catheterization has been routinely done at this institution for the past 19 years to evaluate the left heart. Reviewing the last 250 consecutive transseptal heart catheterizations between 1978 and 1986, the left atrium and ventricle were entered in all but six patients. One death occurred with four other major complications. There were 177 males and 73 females ranging from 18 to 84 years of age. Of these 250 studies, 31 were in association with direct left ventricular apical puncture; 42 were in patients with subaortic stenosis; 101 were in aortic stenosis; 26 were in patients with combined aortic and mitral disease; and four were in patients with triple prosthetic valve replacements. No attempts were made to cross the prosthetic mitral valves. A decline in the number of transseptal studies at this institution has been noted over the past 8 years and the technique is not longer taught routinely to Fellows. The reduction is due to increased emphasis on coronary artery anatomy, fewer rheumatic and prosthetic valvular admissions, and improved reevaluation by non-invasive echocardiography and doppler studies. This has resulted in a loss in proficiency among invasive cardiologists. In conclusion, the transseptal technique is potentially hazardous, but continued usage will maintain proficiency and a low major and minor complication rate.