Amplatzer Septal Occluder to treat iatrogenic cardiac perforations
Valérie Stolt1, Stéphane Cook, Lorenz Räber
1Department of Cardiology, University Hospital, Bern, Switzerland.
Insights
Iatrogenic cardiac perforation can be treated with septal occluder devices. This study shows Amplatzer Septal Occluders (ASO) are a safe and effective option for sealing heart perforations during cardiac procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Iatrogenic free wall cardiac perforation is a rare but life-threatening complication of percutaneous cardiac procedures.
- Septal occluder devices, designed for intracardiac shunts, offer a potential solution for emergency perforation closure.
Purpose of the Study:
- To evaluate the safety and efficacy of using Amplatzer Septal Occluders (ASO) for percutaneous closure of iatrogenic heart perforations.
Main Methods:
- A series of five consecutive cases of iatrogenic heart perforations were treated with ASO implantation.
- Perforations occurred during procedures including left ventricle biopsy, Port-a-Cath dislodgment, transseptal puncture, and post-myocardial infarction ventricular septal defect closure.
Main Results:
- ASO devices of varying sizes (4 mm, 5 mm, 12 mm) were successfully used to close perforations in the left ventricle, right atrium, and free wall.
- All five patients survived the initial 24-hour period post-procedure.
Conclusions:
- Percutaneous device occlusion using ASO appears to be a safe and effective treatment for iatrogenic heart perforation.
- Maintaining catheter access through the perforation site until device deployment is crucial for successful closure.
Background:
Iatrogenic free wall cardiac perforation is a rare but serious complication encountered during percutaneous cardiac procedures, which usually leads to tamponade and death. Septal occluder devices have been developed for sealing intracardiac shunts but may be also used in this emergency setting.
Methods And Results:
We report a small series of five consecutive cases of iatrogenic heart perforations that were treated with implantation of Amplatzer Septal Occluders (ASO). In the first case, iatrogenic left ventricle (LV) perforation occurred during LV biopsy and could be closed up with a 4 mm ASO. In the second case, a 4 mm ASO was used for sealing of a right atrial perforation allocated to Port-a-Cath dislodgment. The third case happened during transseptal puncture for implantation of a TandemHeart bVAD device in a patient suffering cardiogenic shock and was treated by implantation of a 5 mm ASO. The fourth patient was transferred to our facilities for percutaneous closure of an acute post-infarct VSD after anteroseptal myocardial infarction. This procedure was complicated by perforation of the posterolateral free wall and led to the deployment of 12 mm ASO. The last patient suffered from free LV wall perforation during investigation of a severe aortic stenosis and was treated by implantation of 4 mm ASO. All patients were alive after 24 hrs but the last patient died during the in-hospital stay of a right ventricular infarction complicated by multiple organ failure.
Conclusions:
Percutaneous device occlusion of iatrogenic heart perforation seems to be a safe and efficient method to treat iatrogenic heart perforation. In order to perform this elegant method, it is however imperative not to prematurely withdraw the perforating catheter to maintain access to the hole for closure.
