Document Type : Case Report


1 Assistant Professor, Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Associate Professor, Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran


BACKGROUND: Trans-septal puncture (TSP) is a safe and effective method to approach left atrium and ventricle. Nowadays, cardiac electrophysiologists perform this procedure routinely to treat left-sided arrhythmias.CASE REPORT: A 45-year-old man was referred to our center due to Wolff-Parkinson-White (WPW) syndrome. After trans-septal puncture, contrast injection into the sheath showed that it was in the left ventricle (LV) rather than left atrium. Trans-esophageal echocardiography confirmed left ventricle outflow tract to right atrial (RA) jet. Follow-up echocardiography showed that the tract was present up to 18 months, but considering that the patient was asymptomatic, endovascular or surgical closure was not done.CONCLUSION: Our case with an 18-month follow-up period, highlights the conservative approach in asymptomatic patients with this complication.


  1. De Ponti R, Zardini M, Storti C, Longobardi M, Salerno-Uriarte JA. Trans-septal catheterization for radiofrequency catheter ablation of cardiac arrhythmias. Results and safety of a simplified method. Eur Heart J 1998; 19(6): 943-50.
  2. Katritsis GD, Siontis GC, Giazitzoglou E, Fragakis
  3. N, Katritsis DG. Complications of transseptal catheterization for different cardiac procedures. Int J Cardiol 2013; 168(6): 5352-4.
  4. Tsang MY, Hagler DJ, Dearani JA, Rihal CS, Anavekar NS. Aorto-right atrial fistula: A rare complication of trans-septal puncture and catheter ablation for atrial fibrillation. Eur Heart J Cardiovasc Imaging 2014; 15(1): 115.
  5. Claridge S, Kapetanakis S, Gill J, Rinaldi CA, Wright M. A rare complication from transseptal puncture-persistent aorto-right atrial shunt and puncture of noncoronary cusp of aortic valve. Heart Rhythm 2012; 9(12): 2089-90.
  6. Abdi S, Momtahen M, Shafe O. Transcatheter closure of iatrogenic Gerbode defect with an Amplatzer duct occluder in a 23-year-old patient. J Cardiol Cases 2015; 12(2): 45-7.
  7. Can I, Krueger K, Chandrashekar Y, Li JM, Dykoski R, Tholakanahalli VN. Images in cardiovascular medicine. Gerbode-type defect induced by catheter ablation of the atrioventricular node. Circulation 2009; 119(22): e553-e556.
  8. Chavarria N, Goldbarg S. Left ventricle penetration-A rare complication of transseptal puncture and catheter ablation for supraventricular tachycardia. HeartRhythm Case Rep 2015; 1(5): 382-3.