Inadvertent transseptal puncture into the aortic root: The narrow edge between luck and catastrophe in interventional cardiology

Hao Chen, Thomas Fink, Xianzhang Zhan, Minglong Chen, Lars Eckardt, Deyong Long, Jian Ma, Raphael Rosso, Shibu Mathew, Yumei Xue, Weizu Ju, Kristina Wasmer, Changsheng Ma, Jiandu Yang, Tilman Maurer, Bing Yang, Christian Hendrik Heeger, Siew Yen Ho, Karl Heinz Kuck, Shulin WuFeifan Ouyang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Aims: Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root puncture (ARP) due to TSP. Methods and results: All patients with ARP were retrospectively collected from seven hospitals. Aortic root puncture was identified and classified regarding angiographical and intraoperative findings in cardiac surgery: (i) TSP from the right atrium (RA) to the non-coronary sinus (NCS), (ii) TSP from RA to the non-coronary sinutubular junction (STJ), and (iii) TSP from RA to the ascending aorta (AA). A total of 24 patients with inadvertent ARP were identified. In 19 patients, penetration of the aorta was accomplished by the inner dilator, in 5 patients by the complete sheath. Previous cardiac surgery had been performed in six patients. There were 13 RA-to-NCS punctures, 2 RA-to-STJ punctures, and 9 RA-to-AA punctures. No cardiac tamponade (CT) occurred in patients with RA-to-NCS and RA-to-STJ punctures. In 8 of 9 patients with RA-to-AA puncture, CT occurred immediately requiring urgent pericardiocentesis and surgical repair. Two patients died after surgical repair. In the 16 patients without surgical therapy, no shunt from the AR to the RA was observed 3 months after the procedure. Conclusion: Aortic root puncture due to mislead TSP via NCS or STJ is usually not associated with a severe clinical course while ARP into the AA via the epicardial space generally leads to CT requiring surgical repair.

Original languageEnglish
Pages (from-to)1106-1115
Number of pages10
Issue number7
StatePublished - 1 Jul 2019


  • Aorta
  • Cardiac tamponade
  • Catheter ablation
  • Complication
  • Transseptal catheterization
  • Transseptal puncture


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