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Successful percutaneous closure of an iatrogenic right ventricular perforation utilizing an Angio-Seal device: a case
Abdulrahman Arabi1, Amr A Ashour2, Mawahib El Hassan1
1Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Insights
Pericardiocentesis can cause cardiac perforation, but a case report shows a less invasive percutaneous closure device, Angio-Seal, successfully treated right ventricular rupture, offering a promising alternative to surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Pericardiocentesis is a life-saving procedure for pericardial effusion but carries a risk of cardiac perforation.
- Iatrogenic cardiac perforations, especially in high-risk patients, traditionally require open cardiac surgery with significant morbidity.
- This case highlights an alternative management strategy for ventricular perforation during pericardiocentesis.
Observation:
- A 42-year-old male with suspected tuberculosis developed cardiac tamponade requiring pericardiocentesis.
- During the procedure, inadvertent right ventricular (RV) perforation occurred.
- The patient was successfully treated with percutaneous closure of the RV perforation using an Angio-Seal device.
Findings:
- Percutaneous closure of iatrogenic RV perforation using an Angio-Seal device was technically successful.
- The patient experienced no further complications post-procedure.
- Follow-up imaging confirmed successful closure and no worsening of the pericardial effusion.
Implications:
- Percutaneous closure with devices like Angio-Seal may be a viable, less invasive option for managing cardiac perforations during pericardiocentesis.
- This approach could potentially reduce the need for emergency open cardiac surgery in select patients.
- Further studies are warranted to establish the safety and efficacy of this technique in a broader patient population.
Background:
Pericardiocentesis, a procedure with potential life-saving implications, can lead to complications such as cardiac perforation. Emergency open cardiac surgery, the conventional approach for addressing iatrogenic or traumatic cardiac perforations, is associated with unfavourable outcomes in high-risk patients. This report explores a case of accidental iatrogenic right ventricular (RV) puncture, which was effectively managed using a percutaneous closure device.
Case Summary:
A 42-year-old male was hospitalized due to a persistent cough, dyspnoea, and fever, raising suspicion of tuberculosis. He was found to have a large pericardial effusion with signs of impending cardiac tamponade. During an attempted pericardiocentesis at an outside facility, his right ventricle was inadvertently perforated by a catheter. He was transferred to a specialized hospital to be assessed by a cardiac surgeon, where the heart team performed a percutaneous closure of the perforation using an Angio-Seal device, which was successful. A subsequent pericardiectomy was performed to address the effusion and confirm the absence of tuberculosis or malignancy. The patient recovered well, and follow-up imaging showed no worsening of the pericardial effusion. He was discharged in stable condition.
Discussion:
Pericardiocentesis, while crucial for treating large pericardial effusions, carries a small risk of complications such as ventricular perforation. Although surgery is a cornerstone in management, the Angio-Seal device has been used successfully in some cases to repair these tears. In this case, an Angio-Seal device effectively closed a RV rupture, with no further complication seen in follow-up exams. This suggests Angio-Seal as a potentially useful, less invasive option for treating such complications.
