Percutaneous closure of left ventricular puncture after thoracentesis
A 73-years old carrier of aortic and mitral mechanical valves was admitted due to septic shock and a large left empyema for which she underwent thoracentesis. Whirlwind drainage of pulsatile bloody flow was immediately noticed, and the system was clamped. Both the CT scan (figure 1 A,B) and the echo...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Permanyer
2025-08-01
|
| Series: | REC: Interventional Cardiology (English Ed.) |
| Online Access: | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=2610 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | A 73-years old carrier of aortic and mitral mechanical valves was admitted due to septic shock and a large left empyema for which she underwent thoracentesis. Whirlwind drainage of pulsatile bloody flow was immediately noticed, and the system was clamped. Both the CT scan (figure 1 A,B) and the echocardiogram (figure 1C,D) confirmed the malapposition of the 7-Fr pigtail catheter, which was puncturing the left ventricular (LV) wall. Figure 1. After heart team discussion, a percutaneous alternative was considered due to unacceptable high operative risk. After the right femoral artery was cannulated with a 6-Fr introducer sheath, a 0.035 in J guidewire was advanced to the aortic root and a JR4 catheter was used to cross the aortic leaflets, blocking them when snaring the pigtail causing severe hypotension (figure 2A), which made us have to switch to the antegrade approach. We cleaned the catheter internal lumen by advancing a Gaia Second wire (Asahi Intecc, Japan), inflating a 2.5 mm x 20 mm balloon, and removing all thrombotic material (figure 2B). A 400 cm hydrophilic guidewire was, then, advanced to the ascending aorta and snared out creating a LV-right femoral arterial loop. Afterwards, the pigtail catheter was exchanged for a 7-Fr Destination introducer... |
|---|---|
| ISSN: | 2604-7322 |