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Percutaneous transthoracic ventricular puncture for diagnostic and interventional catheterization
D Scott Lim1, Michael Ragosta, John M Dent
1Department of Pediatrics and Medicine, University of Virginia, Virginia, USA. SL9PC@virginia.edu
Insights
Direct ventricular puncture enables percutaneous interventions in patients with mechanical heart valves, allowing sheath placement up to 9-F. Careful attention to puncture site is crucial to avoid complications like hemothorax.
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.
Objective:
To describe our experience in a case series of patients requiring percutaneous direct ventricular puncture and sheath placement for diagnosis or intervention.
Background:
Access to the right or left ventricle for percutaneous interventions is limited in patients with mechanical prostheses in either the tricuspid, or mitral and aortic positions.
Methods:
After coronary angiography, direct ventricular puncture under ultrasound and fluoroscopic guidance was performed. At end of case, protamine was given to reverse the heparin, and sheaths were pulled with purse-string suture closure of the skin entrance.
Results:
For right ventricular access, 8- to 9-F sheaths were placed from subxiphoid approach in 2 patients to allow conduit and pulmonary artery interventions. For left ventricular access in patients with mitral and aortic prostheses, 4- to 8-F sheaths were placed from apical approach to allow diagnostic evaluation in 1 and interventions in 5 to occlude perivalvular mitral leaks and postoperative ventricular septal defect. Complication in one consisted of intercostal vein injury resulting in hemothorax requiring chest tube drainage.
Conclusion:
In this small cases series, direct ventricular puncture allowed the intervention to proceed with up to 9-F sheath size. Attention to puncture site relative to intercostal vascular anatomy is warranted.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:24Cardiac Catheterization III: Left Heart Catheterization
01:21Cardiac Catheterization II: Right Heart Catheterization
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...