ArticleEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2022
Computed tomography-based selection of transseptal puncture site for percutaneous left atrial appendage closure.
Article in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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17 citing papers in PubMed, 26 citations in OpenAlex.
- Left Atrial Appendage: Mere Spectator or Protagonist? A Narrative Review of Its Multimodal Imaging Assessment and Its Closure Techniques.Journal of clinical medicine · 2026Review
- Descending Aorta Perforation During Transseptal Puncture for Left Atrial Appendage Closure.JACC. Case reports · 2026Article
- Retro-Curve Access Sheath for Retroverted Anatomy in Left Atrial Appendage Closure: Bench Validation and Patient-Specific Simulation Study.Structural heart : the journal of the Heart Team · 2026Article
- Occlusion effects, safety, and clinical prognosis of Watchman and LAmbre occluders in left atrial appendage closure.BMC cardiovascular disorders · 2026Article
- Transseptal Puncture for Left Atrial Appendage Closure: A Consensus Document From the Second European Left Atrial Appendage Club.Journal of the Society for Cardiovascular Angiography & Interventions · 2026Review
- Clinical application of the transseptal puncture technique using a biplane positioning method with left atrial 3D-CT.Frontiers in cardiovascular medicine · 2026Article
- 2025 SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Atrial Appendage Occlusion.Journal of the Society for Cardiovascular Angiography & Interventions · 2025Article
- Understanding Cardiac Anatomy and Imaging to Improve Safety of Procedures: The Left Atrial Appendage.JACC. Case reports · 2025Article
- Cardiac CT for electrophysiological interventions.The international journal of cardiovascular imaging · 2025Review
- Advancements in 3D Transoesophageal Echocardiography (TOE) and Computed Tomography (CT) for Stroke Prevention in Left Atrial Appendage Occlusion Interventions.Journal of clinical medicine · 2024Review
- Concomitant left atrial appendage occlusion in patients undergoing mitral transcatheter edge-to-edge repair: pros and cons.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2024Article
- Bayesian Optimization Based Preprocedural Planning For Robotic Left Atrial Appendage Occlusion.... International Symposium on Medical Robotics. International Symposium on Medical Robotics · 2024Article
- State-of-the-Art of Transcatheter Left Atrial Appendage Occlusion.Journal of clinical medicine · 2024Review
- Intracardiac echocardiography is a promising strategy for guiding closure of the left atrial appendage.Health science reports · 2023Review
- Left atrial appendage occlusion.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2023Review
- Left atrial appendage closure in patients with reversed chicken-wing morphology: Anatomical features and procedural strategy.Heliyon · 2023Article
- How to Monitor Transseptal Puncture: A Consensus Statement of the Italian Society of Echocardiography and Cardiovascular Imaging.Journal of cardiovascular echographyArticle
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAn inferoposterior transseptal puncture (TSP) is generally recommended for percutaneous left atrial appendage (LAA) closure. However, the LAA is a highly variable anatomical structure. This may have an impact on the preferred TSP site.
aimsThis study aimed to determine the optimal TSP site for percutaneous LAA closure in different LAA morphologies.
methodsIn this prospective study, 182 patients undergoing percutaneous LAA closure were included. The spatial relationship of the LAA to the fossa ovalis and its consequence for TSP was assessed at preprocedural cardiac computed tomography (CCT).
resultsBased on CCT analysis, it was predicted that coaxial alignment between the delivery sheath and the LAA would be obtained by an inferoposterior, inferocentral, or inferoanterior TSP in 75%, 16% and 8% of cases, respectively. This was also confirmed by procedural LAA angiogram in 175 cases (96%) with <30° angle between the delivery sheath and the LAA central axis. Multivariate logistic regression analysis identified reverse chicken wing LAA (odds ratio [OR] 6.36 [1.85-29.3]; p=0.005) and posterior bending of the proximal LAA (OR 17.2 [3.3-96.2]; p<0.001) as independent predictors of a central or anterior TSP - this to increase the chance of obtaining coaxial alignment between the delivery sheath and the LAA.
conclusionsAn inferoposterior TSP is recommended in the majority of percutaneous LAA closure procedures in order to obtain coaxial alignment between the delivery sheath and the LAA. An inferior but more central/anterior TSP should be recommended in case of a reverse chicken wing LAA or posterior bending of the proximal LAA, which occurs in 20-25% of cases.
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