JCK-AP session 7-1 (III-JCKAP7-1)
Interventional cardiology 1

[III-JCKAP7-1-2] Wire Atrial Septostomy with Reversed TransSeptal Puncture: Advanced methods in ASD creation.

^○Yusaku Nagatomo, Ryohei Matsuoka, Masaru Kobayashi, Daisuke Toyomura, Eiko Terashi, Yuichiro Hirata, Hazumu Nagata, Kenichiro Yamamura, Shouichi Ohga (The Department of Pediatrics, Kyushu University Hospital, Fukuoka)

キーワード：ASD creation, Septostomy, RF wire

Wire atrial septostomy (WAS) is a novel technique to create an ASD using a thin wire, reported by Kitano et al. in 2020. This technique involves creating another ASD adjacent to the original ASD, making a wire loop between the two ASDs, and cutting the septal tissue by pulling the loop into a sheath, thereby connecting the two ASDs. The WAS procedure involves transseptal puncture (TSP). It should be performed appropriately adjacent to the original ASD. However, the difficulty of adjusting the TSP site and the procedural complexity of the wire loop were issues to be solved. We have reported reversed TSP as a useful method.
An RF wire can be passed through a pigtail catheter by bending its tip manually. This allows reversed TSP from the left to the right atrium through a pigtail catheter hooked on the septum. Cutting the tip of the pigtail catheter and steering the microcatheter allows adjusting the curve of the pigtail catheter. In addition, the wire loop can be easily made following the reversed TSP.
We have performed WAS with reversed TSP in four pediatric patients and accomplished the ideal ASD creation. The preceded conventional BAS was ineffective because they had a thickened septum, floppy septum, and too small left atrium. In the two cases, the superior margin ASD was enlarged towards the center of the septum by adjusting reversed TSP; in the other two cases, the foramen ovale was completely closed, so forward TSP was followed by reversed TSP and WAS. Careful simulation of these procedures in advance enabled the speedy and safe ASD creation, even in neonatal cases.