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. 2008 Wiley-Liss, Inc.
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. 2008 Wiley-Liss, Inc.
Authors: Joseph M Venturini; Isla McClelland; John E A Blair; Akhil Narang; Rohan Kalathiya; Roberto M Lang; Karima Addetia; Jonathan Paul; Sandeep Nathan; Atman P Shah Journal: J Invasive Cardiol Date: 2019-06-15 Impact factor: 2.022
Authors: Israel M Barbash; Christina E Saikus; Anthony Z Faranesh; Kanishka Ratnayaka; Ozgur Kocaturk; Marcus Y Chen; Jamie A Bell; Renu Virmani; William H Schenke; Michael S Hansen; Michael C Slack; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2011-12 Impact factor: 11.195
Authors: Kanishka Ratnayaka; Christina E Saikus; Anthony Z Faranesh; Jamie A Bell; Israel M Barbash; Ozgur Kocaturk; Christine A Reyes; Merdim Sonmez; William H Schenke; Victor J Wright; Michael S Hansen; Michael C Slack; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2011-12 Impact factor: 11.195