Angio-Seal for Right Ventricle Perforation During Pericardiocentesis for Cardiac Tamponade: A Case Report

Cardiac tamponade is often managed with pericardiocentesis, carrying a 1% to 4% complication risk, including right ventricle perforation. Small punctures are typically managed conservatively, while larger ones require cardiac surgery. This case describes percutaneous Angio-Seal (Terumo) repair in a high-risk surgical patient. A 46-year-old obese woman with multiple comorbidities presented with recurrent tamponade. After inserting a pericardiocentesis catheter it was noticed that despite draining 1000 mL of blood, tamponade persisted. The catheter was inadvertently placed in the right ventricle. After anticoagulation subsided, an 8F Angio-Seal catheter was deployed under imaging, successfully sealing the perforation. This case highlights the safety of Angio-Seal in high-risk patients with right ventricle perforation.