{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:25:48Z","timestamp":1787563548736,"version":"build-2736575974"},"reference-count":28,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Interv Cardiol"],"abstract":"<jats:p>Atrial septal defect and patent foramen ovale are common congenital heart defects in adults, often treated with atrial septal occluders (ASOs) via percutaneous closure. Transseptal puncture (TSP) for left atrial interventions in patients with ASOs presents procedural challenges, requiring detailed pre-procedural planning and imaging. Transoesophageal echocardiography and cardiac CT help identify optimal puncture sites, either through the native septum or across the ASO. Advanced techniques, such as balloon-assisted tracking and radiofrequency energy delivery, aid in navigating the device. TSP is frequently performed for procedures such as pulmonary vein isolation, left atrial appendage occlusion, and mitral valve interventions. While generally safe and effective, TSP can lead to complications including residual shunting and device deformation, or procedural delays. Specialised expertise and multimodality imaging are crucial for optimising success and minimising risks. This review outlines TSP techniques, clinical applications and strategies for navigating ASOs during left atrial interventions.<\/jats:p>","DOI":"10.15420\/icr.2025.08","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T12:04:26Z","timestamp":1764504266000},"source":"Crossref","is-referenced-by-count":1,"title":["Breaking the Barriers: Transseptal Puncture in Patients with Atrial Septal Defect Closure Devices"],"prefix":"10.15420","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6701-0308","authenticated-orcid":false,"given":"Gerardo","family":"Lo Russo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9065-3261","authenticated-orcid":false,"given":"Roberto","family":"Nerla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Sanseviero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5430-0194","authenticated-orcid":false,"given":"Gianluca","family":"Pillitteri","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01bnjbv91","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Sassari"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Cubich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Sbarzaglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4055-5062","authenticated-orcid":false,"given":"Marco","family":"Toselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5936-9863","authenticated-orcid":false,"given":"Fausto","family":"Castriota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Haas NA, Driscoll DJ, Rickert-Sperling S. Clinical presentation and therapy of atrial septal defect. Adv Exp Med Biol 2024;1441:461\u20136. https:\/\/doi.org\/10.1007\/978-3-031-44087-8_23; PMID:\u00a038884725.","DOI":"10.1007\/978-3-031-44087-8_23"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Koutroulou I, Tsivgoulis G, Tsalikakis D, et al. Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review. Front Neurol 2020;11:281. https:\/\/doi.org\/10.3389\/fneur.2020.00281; PMID:\u00a032411074.","DOI":"10.3389\/fneur.2020.00281"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Muroke V, Jalanko M, Haukka J, et al. Outcome of transcatheter atrial septal defect closure in a nationwide cohort. Ann Med 2023;55:615\u201323. https:\/\/doi.org\/10.1080\/07853890.2023.2178669; PMID:\u00a036786506.","DOI":"10.1080\/07853890.2023.2178669"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Apostolos A, Tsiachris D, Drakopoulou M, et al. Atrial fibrillation after patent foramen ovale closure: incidence, pathophysiology, and management. J Am Heart Assoc 2024;13:e034249. https:\/\/doi.org\/10.1161\/jaha.124.034249; PMID:\u00a038639354.","DOI":"10.1161\/JAHA.124.034249"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Alkhouli M, Rihal CS, Holmes DR. Transseptal techniques for emerging structural heart interventions. JACC Cardiovasc Interv 2016;9:2465\u201380. https:\/\/doi.org\/10.1016\/j.jcin.2016.10.035; PMID:\u00a028007198.","DOI":"10.1016\/j.jcin.2016.10.035"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Guo Q, Sang C, Bai R, et al. Transseptal puncture in patients with septal occluder devices during catheter ablation of atrial fibrillation. EuroIntervention 2022;17:1112\u20139. https:\/\/doi.org\/10.4244\/eij-d-21-00340; PMID:\u00a034219664.","DOI":"10.4244\/EIJ-D-21-00340"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Fitzpatrick N, Keaney J, Keelan E, et al. Picking the locked door: Experiences and techniques in transseptal puncture post-atrial septal defect occlusion. JACC Case Rep 2023;14:101827. https:\/\/doi.org\/10.1016\/j.jaccas.2023.101827; PMID:\u00a037077870.","DOI":"10.1016\/j.jaccas.2023.101827"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Sang CH, Dong JZ, Long DY, et al. Transseptal puncture and catheter ablation of atrial fibrillation in patients with atrial septal occluder: Initial experience of a single centre. Europace 2018;20:1468\u201374. https:\/\/doi.org\/10.1093\/europace\/eux282; PMID:\u00a029106529.","DOI":"10.1093\/europace\/eux282"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Chen K, Sang C, Dong J, Ma C. Transseptal puncture through Amplatzer septal occluder device for catheter ablation of atrial fibrillation: use of balloon dilatation technique. J Cardiovasc Electrophysiol 2012;23:1139\u201341. https:\/\/doi.org\/10.1111\/j.1540-8167.2012.02306.x; PMID:\u00a022510167.","DOI":"10.1111\/j.1540-8167.2012.02306.x"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Santangeli P, Di Biase L, Burkhardt JD, et al. Transseptal access and atrial fibrillation ablation guided by intracardiac echocardiography in patients with atrial septal closure devices. Heart Rhythm 2011;8:1669\u201375. https:\/\/doi.org\/10.1016\/j.hrthm.2011.06.023; PMID:\u00a021703215.","DOI":"10.1016\/j.hrthm.2011.06.023"},{"key":"ref10","unstructured":"Merchant FM, Delurgio DB. Site-specific transseptal cardiac catheterization guided by intracardiac echocardiography for emerging electrophysiology applications. J Innov Card Rhythm Manag 2013;4:1415\u201327. https:\/\/doi.org\/10.19102\/icrm.2013.041007."},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Bazaz R, Schwartzman D. Site-selective atrial septal puncture. J Cardiovasc Electrophysiol 2003;14:196\u20139. https:\/\/doi.org\/10.1046\/j.1540-8167.2003.02377.x; PMID:\u00a012693505.","DOI":"10.1046\/j.1540-8167.2003.02377.x"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Cai C, Wang J, Niu HX, et al. Optimal lesion size index for pulmonary vein isolation in high-power radiofrequency catheter ablation of atrial fibrillation. Front Cardiovasc Med 2022;9:869254. https:\/\/doi.org\/10.3389\/fcvm.2022.869254; PMID:\u00a035463774.","DOI":"10.3389\/fcvm.2022.869254"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Chen S, Chun JKR, Bordignon S, et al. Pulsed field ablation-based pulmonary vein isolation in atrial fibrillation patients with cardiac implantable electronic devices: practical approach and device interrogation (PFA in CIEDs). J Interv Card Electrophysiol 2023;66:1929\u201338. https:\/\/doi.org\/10.1007\/s10840-022-01445-0; PMID:\u00a036481833.","DOI":"10.1007\/s10840-022-01445-0"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Li X, Wissner E, Kamioka M, et al. Safety and feasibility of transseptal puncture for atrial fibrillation ablation in patients with atrial septal defect closure devices. Heart Rhythm 2014;11:330\u20135. https:\/\/doi.org\/10.1016\/j.hrthm.2013.11.011; PMID:\u00a024239844.","DOI":"10.1016\/j.hrthm.2013.11.011"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Gloekler S, Shakir S, Meier B. Transseptal puncture through Amplatzer atrial septal occluder for left atrial appendage closure. JACC Cardiovasc Interv 2017;10:2222\u20133. https:\/\/doi.org\/10.1016\/j.jcin.2017.04.038; PMID:\u00a029122135.","DOI":"10.1016\/j.jcin.2017.04.038"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Korsholm K, Jensen JM, Nielsen-Kudsk JE. Left atrial appendage occlusion guided by intracardiac echocardiography in a patient with a 34 mm atrial septal defect occluder: a case report. Eur Heart J Case Rep 2023;7:ytad571. https:\/\/doi.org\/10.1093\/ehjcr\/ytad571; PMID:\u00a038046651.","DOI":"10.1093\/ehjcr\/ytad571"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Nadel J, Subbiah R, Jacobs N, et al. Successful left atrial appendage closure in a patient with prior patent foramen ovale occlusion. HeartRhythm Case Rep 2019;5:183\u20136. https:\/\/doi.org\/10.1016\/j.hrcr.2018.11.018; PMID:\u00a030997330.","DOI":"10.1016\/j.hrcr.2018.11.018"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Heersink D, Murdoch D, Humphries J, Walters DL. Left atrial appendage closure device implantation after percutaneous atrial septal defect closure. JACC Cardiovasc Interv 2016;9:e95\u20136. https:\/\/doi.org\/10.1016\/j.jcin.2016.02.019; PMID:\u00a027131442.","DOI":"10.1016\/j.jcin.2016.02.019"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"\u00c7\u00f6teli C, Canpolat U, Kaya EB, et al. Left atrial appendage closure using Amulet device in a patient with prior percutaneous atrial septal defect closure. Turk Kardiyol Dern Ars 2018;46:306\u20138. https:\/\/doi.org\/10.5543\/tkda.2018.44884; PMID:\u00a029853699.","DOI":"10.5543\/tkda.2018.44884"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Villablanca PA, Lee J, Wang DD, et al. Transseptal puncture through an Amplatzer atrial septal occluder for edge-to-edge repair with MitraClip NTr system. Cardiovasc Revasc Med 2020;21:63\u20134. https:\/\/doi.org\/10.1016\/j.carrev.2020.02.021; PMID:\u00a032224042.","DOI":"10.1016\/j.carrev.2020.02.021"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Mehta R, Hudock K, Shreenivas S. How to go trans-septal if the door is closed: MitraClip placement in a patient with prior atrial septal defect closure device with the assistance of 3-D printing. Structural Heart 2019;3:158\u20139. https:\/\/doi.org\/10.1080\/24748706.2018.1554276.","DOI":"10.1080\/24748706.2018.1554276"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Niikura H, Burns M, Bae R, Sorajja P. Transcatheter mitral valve repair in a patient with prior atrial septal defect occlusion. EuroIntervention 2021;16:e1272\u20133-e1273. https:\/\/doi.org\/10.4244\/eij-d-19-01064; PMID:\u00a031985454.","DOI":"10.4244\/EIJ-D-19-01064"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"De Ponti R, Cappato R, Curnis A, et al. Trans-septal catheterization in the electrophysiology laboratory: data from a multicenter survey spanning 12 years. J Am Coll Cardiol 2006;47:1037\u201342. https:\/\/doi.org\/10.1016\/j.jacc.2005.10.046; PMID:\u00a016516090.","DOI":"10.1016\/j.jacc.2005.10.046"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Roelke M, Smith AJ, Palacios IF. The technique and safety of transseptal left heart catheterization: the Massachusetts General Hospital experience with 1,279 procedures. Cathet Cardiovasc Diagn 1994;32:332\u20139. https:\/\/doi.org\/10.1002\/ccd.1810320409; PMID:\u00a07987913.","DOI":"10.1002\/ccd.1810320409"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Saluveer O, Bastani H, Verouhis D, et al. Transseptal access through an atrial septal defect closure device resulting in open heart surgery. JACC Case Rep 2022;4:685\u20137. https:\/\/doi.org\/10.1016\/j.jaccas.2022.04.006; PMID:\u00a035677791.","DOI":"10.1016\/j.jaccas.2022.04.006"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Dimitriadis K, Pyrpyris N, Karampinos K, et al. Iatrogenic atrial septal defects in structural heart interventions: opening the Pandora\u2019s box. Catheter Cardiovasc Interv 2024;104:1299\u2013315. https:\/\/doi.org\/10.1002\/ccd.31237; PMID:\u00a039300820.","DOI":"10.1002\/ccd.31237"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Simard T, El Sabbagh A, Lane C, et al. Anatomic approach to transseptal puncture for structural heart interventions. JACC Cardiovasc Interv 2021;14:1509\u201322. https:\/\/doi.org\/10.1016\/j.jcin.2021.04.037; PMID:\u00a034294395.","DOI":"10.1016\/j.jcin.2021.04.037"}],"container-title":["Interventional Cardiology Reviews Research Resources"],"original-title":[],"link":[{"URL":"https:\/\/www.icrjournal.com\/articleindex\/icr.2025.08","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T12:04:29Z","timestamp":1764504269000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.icrjournal.com\/articleindex\/icr.2025.08"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":28,"URL":"https:\/\/doi.org\/10.15420\/icr.2025.08","relation":{},"ISSN":["1756-1477","1756-1485"],"issn-type":[{"value":"1756-1477","type":"print"},{"value":"1756-1485","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]},"article-number":"e33"}}