Percutaneous transthoracic ventricular puncture for diagnostic and interventional catheterization

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Percutaneous interventions in the ventricles are challenging in patients with mechanical heart prostheses.
• Limited access options exist for ventricular procedures in patients with prosthetic valves.

Purpose of the Study:

• To report on the feasibility and outcomes of percutaneous direct ventricular puncture and sheath placement.
• To evaluate this technique for diagnostic and interventional purposes in specific patient populations.

Main Methods:

• Direct ventricular puncture performed under ultrasound and fluoroscopic guidance.
• Sheath placement (4-9F) via subxiphoid or apical approaches.
• Heparin reversal with protamine and purse-string closure at procedure end.

Main Results:

• Successful ventricular access achieved for interventions in 7 patients.
• Right ventricular access (8-9F sheaths) for conduit and pulmonary artery interventions.
• Left ventricular access (4-8F sheaths) for perivalvular leak occlusion and VSD closure.
• One complication: hemothorax from intercostal vein injury.

Conclusions:

• Direct ventricular puncture is a viable approach for percutaneous interventions in challenging cases.
• The technique allows for the use of larger sheaths (up to 9F).
• Awareness of local vascular anatomy is essential to minimize risks.