Pathological study of the transseptal puncture site of interatrial septum in catheter interventions

: Pathological changes in the transseptal puncture site of the interatrial septum were studied in seven autopsy patients in whom transseptal puncture had occurred during catheter interventions under transesophageal echocardiography monitoring. 1. In one patient with chronic renal failure who had received hemodialysis for more than 10 years, the transseptal puncture was unsuccessful. The failure is attributable to the severe calcification of the left atrial wall and interatrial septum. The autopsy showed only a small scratch on the fossa ovalis in the right atrial side. 2. The puncture hole was round in five patients and a slit in one, without tearing or extension from the puncture hole. 3. Late closure of the transseptal puncture hole was observed in two patients who died 7 and 22 days after the intervention procedures. 4. Mild infiltration of red blood cells around the transseptal puncture hole was detected in two patients. One died immediately after left atrio-arterial bypass support and another died on the 24th day after percutaneous transvenous mitral commissurotomy. Both patients showed tendency to bleeding due to heparinization and/or coagulopathy treatment during the clinical course. 5. Autopsy specimens demonstrated that the transseptal puncture was performed just on the fossa ovalis in all patients. 6. Biplanar transesophageal echocardiography is a very effective guidance method for transseptal puncture during catheter interventions.