Intracardiac ultrasound-guided transseptal puncture in horses: Outcome, follow-up, and perioperative anticoagulant treatment.
Authors: Vernemmen Ingrid, Buschmann Eva, Van Steenkiste Glenn, Demeyere Marie, Verhaeghe Lize-Maria, De Somer Filip, Devreese Katrien M J, Schauvliege Stijn, Decloedt Annelies, van Loon Gunther
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary Transseptal puncture (TSP) has traditionally been underutilised in equine cardiology because accessing the left heart typically requires arterial catheterisation, but this Belgian study demonstrates that ultrasound-guided TSP can be reliably performed in healthy horses under general anaesthesia, with successful catheter placement achieved in all 11 cases within a median of 22 minutes. Cardiac troponin I levels rose postoperatively but remained within reference ranges in 10 of 11 horses, whilst the iatrogenic atrial septal defects created by the puncture closed spontaneously within two weeks in all cases, suggesting the technique induces minimal myocardial damage and requires no surgical intervention for defect repair. Atrial arrhythmias occurred frequently during and immediately after the procedure (9 of 11 horses experienced atrial premature depolarisations, tachycardia, or fibrillation), though the clinical significance of these transient events remains to be determined. The study also evaluated enoxaparin anticoagulation protocols, revealing that activated clotting time correlated with anti-factor Xa activity in vitro but not in vivo, indicating that current laboratory monitoring may not accurately reflect in-vivo anticoagulant efficacy in horses. For equine practitioners, this work opens a new diagnostic avenue for characterising and potentially treating left-sided cardiac arrhythmias—a significant knowledge gap in equine cardiology—though further investigation into perioperative arrhythmia management and long-term outcome data will be necessary before widespread clinical adoption.
Read the full abstract on PubMed
Practical Takeaways
- •Transseptal puncture is a safe and technically feasible approach for accessing the left heart in horses, enabling future diagnosis and treatment of left-sided cardiac arrhythmias
- •Expect atrial arrhythmias as a common perioperative complication (81% incidence), but these appear manageable with appropriate monitoring and anticoagulation
- •No intervention is required for closure of the iatrogenic atrial septal defect as spontaneous complete closure occurs within 5 weeks in all cases
Key Findings
- •Transseptal puncture was successfully achieved in all 11 horses with median procedure time of 22 minutes (range 10-104)
- •Atrial arrhythmias occurred in 9/11 horses (82%), including atrial fibrillation in 3 horses, atrial tachycardia in 5 horses, and atrial premature depolarizations in 1 horse
- •Spontaneous closure of iatrogenic atrial septal defect occurred in all horses with median closure time of 14 days (range 1-35 days)
- •Serum cardiac troponin I increased after puncture but remained below reference values in 10/11 horses, indicating minimal myocardial injury