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Santangeli P, Hyman MC, Muser D, Callans DJ, Shivkumar K, Marchlinski FE. Outcomes of Percutaneous Trans-Right Atrial Access to the Left Ventricle for Catheter Ablation of Ventricular Tachycardia in Patients With Mechanical Aortic and Mitral Valves. JAMA Cardiol 2020; 6:2770997. [PMID: 32997112 PMCID: PMC7941197 DOI: 10.1001/jamacardio.2020.4414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/22/2020] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In patients with mechanical valves in the aortic and mitral positions, percutaneous access to the left ventricle (LV) via a transfemoral approach for catheter ablation of ventricular tachycardia (VT) has been considered infeasible. OBJECTIVE To describe the outcomes of a novel percutaneous trans-right atrial (RA) access to the LV via a femoral venous approach for catheter ablation of VT in patients with mechanical aortic and mitral valves. DESIGN, SETTING, AND PARTICIPANTS This observational study included consecutive patients with mechanical valves in the aortic and mitral positions and recurrent monomorphic drug-refractory VT associated with an LV substrate. Percutaneous LV access was performed from a transfemoral venous route with the aid of a deflectable sheath and a radiofrequency wire by creating an iatrogenic Gerbode defect with direct puncture of the inferior and medial aspect of the RA, adjacent to the inferior-septal process of the LV (ISP-LV), under intracardiac echography guidance. Once the wire crossed to the LV, balloon dilatation of the ventriculotomy site (with a noncompliant balloon; diameter, 8 to 10 mm) was performed to facilitate passage of the sheath within the LV. EXPOSURES Percutaneous trans-RA access to the LV via puncture of the ISP-LV to perform catheter ablation of VT in patients with mechanical aortic and mitral valves. MAIN OUTCOMES AND MEASURES Feasibility and safety of a trans-RA access to the LV for catheter ablation of VT. RESULTS A total of 4 patients (mean [SD] age, 60 [7] years; mean [SD] LV ejection fraction, 31% [9%]) with recurrent VT associated with an LV substrate (ischemic cardiomyopathy, 3 patients; nonischemic cardiomyopathy, 1 patient) and mechanical valves in the aortic and mitral position underwent trans-RA access through the ISP-LV for catheter ablation of VT. The time to obtain LV access ranged from 60 minutes (first case) to 22 minutes (last case) (mean [SD], 36 [15] minutes). No complications associated with the access occurred. In particular, in the 3 patients with preserved atrioventricular conduction at baseline, no new conduction abnormalities were observed after the access. Complete VT noninducibility at programmed ventricular stimulation was achieved in 3 cases, and no patient had VT recurrence at a median follow-up of 14 months (range, 6-21 months). CONCLUSIONS AND RELEVANCE A percutaneous trans-RA access to the LV via a femoral venous approach for catheter ablation of VT in patients with mechanical aortic and mitral valves is feasible and appears safe. This novel technique may allow for catheter ablation of VT in a population of patients in whom conventional LV access via retrograde aortic or atrial transseptal routes is not possible.
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Affiliation(s)
- Pasquale Santangeli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C. Hyman
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniele Muser
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J. Callans
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Francis E. Marchlinski
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Eng MH, Kherallah RY, Guerrero M, Greenbaum AB, Frisoli T, Villablanca P, Wang DD, Lee J, Wyman J, O'Neill WW. Complete percutaneous apical access and closure: Short and intermediate term outcomes. Catheter Cardiovasc Interv 2020; 96:481-487. [PMID: 31957915 DOI: 10.1002/ccd.28731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/12/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To examine the safety of utilizing transapical access during structural interventions. BACKGROUND Complex interventions of the mitral or aortic region sometimes require coaxial forces to orient and deliver devices. Apical access can provide coaxial countertraction for either transseptal or retrograde aortic access. This manuscript describes the single center experience of small bore transapical access. METHODS Retrospective review of cases from 2013 to 2018 at Henry Ford Hospital was performed. Patient demographics and procedure characteristics were abstracted to describe the safety of transapical access using small bore sheaths. RESULTS A total 21 cases were performed at Henry Ford, most of them for transcatheter mitral valve replacement (81%). The mean sheath size used was 4.7 ± 0.9 Fr and protamine was used at the end of 57% of cases. All patients received nitinol-based plugs, 80.1% were from the Amplatz Duct Occluder II type. Four major complications related apical puncture occurred, two pericardial effusions, two hemothorax. Over a median follow time of 430 days (IQR 50-652) a total of five deaths occurred, two related to the procedure and three late deaths with a median time of 362 days (range 205-628 days). No deaths were associated with transapical access. Echocardiographic follow up did not detect any late structural complications from occluder devices. CONCLUSIONS Transapical access and closure with nitinol-based devices is feasible and facilitates complex interventions where coaxial forces are need for device delivery and alignment. The most common complication is bleeding and this should be kept in perspective when treating high-risk patients.
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Affiliation(s)
- Marvin H Eng
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | | | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Adam B Greenbaum
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia
| | - Tiberio Frisoli
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - Pedro Villablanca
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - Dee Dee Wang
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - James Lee
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - Janet Wyman
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - William W O'Neill
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
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Santangeli P, Shaw GC, Marchlinski FE. Radiofrequency Wire Facilitated Interventricular Septal Access for Catheter Ablation of Ventricular Tachycardia in a Patient With Aortic and Mitral Mechanical Valves. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004771. [DOI: 10.1161/circep.116.004771] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/25/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Pasquale Santangeli
- From the Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - George C. Shaw
- From the Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E. Marchlinski
- From the Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
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Ahn HC, Baranowski J, Dahlin LG, Nielsen NE. Transvenous Implantation of a Stent Valve in Patients With Degenerated Mitral Prostheses and Native Mitral Stenosis. Ann Thorac Surg 2016; 101:2279-84. [PMID: 26897322 DOI: 10.1016/j.athoracsur.2015.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to report the use of a transvenous transseptal approach using a stent valve in patients with degenerated biological mitral valve prostheses, regurgitation after mitral repair, and native mitral stenosis. METHODS Ten patients (median age, 74 years; range, 20-89 years; 5 men and 5 women) with degenerated mitral bioprosthetic valves (n = 7), failed mitral repair (n = 1), or calcified native stenotic valves (n = 2) underwent transvenous implantation of a stent valve. RESULTS The procedure was initially successful in all patients. Predilation was performed for balloon sizing only in the 2 patients with native mitral stenosis. The stent valve was deployed during 1 period of rapid pacing. A guidewire, as a loop from the right femoral vein and through the left ventricular apex, facilitated a good angle and secure positioning of the stent valve. An ultrasonographically guided puncture of the apex was carried out in 6 patients, and in the other 4 we performed a minithoracotomy before apical puncture. All valves were implanted in a good position with improved function and without significant paravalvular leakage (PVL). There were no periprocedural deaths. The 30-day survival was 80% (8 of 10 patients), and 60% (6 of 10) of patients were still alive a median time of 290 days after the procedure. CONCLUSIONS Transvenous transseptal implantation of a stent valve was performed in 10 patients with mitral valve disease, with good early functional results. These high-risk patients must be carefully selected by a multidisciplinary team because the procedure carries a high mortality.
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Affiliation(s)
- Henrik Casimir Ahn
- Department of Cardiothoracic Surgery, Institution of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
| | - Jacek Baranowski
- Department of Physiology, Institution of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Lars-Goran Dahlin
- Department of Cardiothoracic Surgery, Institution of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Niels Erik Nielsen
- Department of Cardiology, Institution of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
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Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. The Learning Curve in Percutaneous Repair of Paravalvular Prosthetic Regurgitation. JACC Cardiovasc Interv 2014; 7:521-9. [DOI: 10.1016/j.jcin.2014.01.159] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/04/2014] [Indexed: 12/30/2022]
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Cullen MW, Cabalka AK, Alli OO, Pislaru SV, Sorajja P, Nkomo VT, Malouf JF, Cetta F, Hagler DJ, Rihal CS. Transvenous, antegrade Melody valve-in-valve implantation for bioprosthetic mitral and tricuspid valve dysfunction: a case series in children and adults. JACC Cardiovasc Interv 2013; 6:598-605. [PMID: 23683739 DOI: 10.1016/j.jcin.2013.02.010] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/01/2013] [Accepted: 02/02/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to report the results of percutaneous valve-in-valve therapy using the Melody valve (Medtronic, Minneapolis, Minnesota) for patients with degenerated mitral and tricuspid bioprosthetic valves. BACKGROUND Open surgery for replacement of degenerated bioprosthetic valves is associated with morbidity and mortality. METHODS Nineteen patients (median age 65 years, range 10 to 88 years; 7 males) with degenerated mitral (n = 9) or tricuspid (n = 10) bioprosthetic valves underwent transvenous valve-in-valve implantation of the Melody valve. RESULTS In the mitral patients, the mean Society of Thoracic Surgeons mortality score was 13.3 ± 5.6%. All patients had a prosthetic valve mean diastolic inflow gradient ≥5 mm Hg. Moderate or worse regurgitation was present in 7 of 9 mitral and 7 of 10 tricuspid patients. Implantation of a Melody valve was successful in all. Among the mitral patients, mean diastolic gradient decreased from 12.3 ± 4.6 mm Hg to 5.2 ± 2 mm Hg (p < 0.01). Residual regurgitation was trivial to mild in 6, mild to moderate in 2, and moderate in 1 patient. Among the tricuspid patients, mean diastolic gradient decreased from 10.0 ± 4.3 mm Hg to 5.6 ± 2.5 mm Hg (p < 0.01). Residual regurgitation was trivial to mild in 9 and mild to moderate in 1 patient. New York Heart Association functional class improved in 17 of 19 patients (p < 0.01). No periprocedural deaths, myocardial infarctions, strokes, or valve embolizations occurred. Vascular access site complications occurred in 4 patients. CONCLUSIONS Percutaneous valve-in-valve implantation of the Melody valve in the mitral or tricuspid position for treatment of bioprosthetic valve dysfunction is feasible and can lead to significant symptomatic improvement in carefully selected high-risk patients.
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Affiliation(s)
- Michael W Cullen
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
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Vaseghi M, Macias C, Tung R, Shivkumar K. Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: a novel technique for catheter ablation of ventricular tachycardia. Heart Rhythm 2013; 10:1069-73. [PMID: 23643678 DOI: 10.1016/j.hrthm.2013.04.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California 90095, USA
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Principles of percutaneous paravalvular leak closure. JACC Cardiovasc Interv 2012; 5:121-30. [PMID: 22361595 DOI: 10.1016/j.jcin.2011.11.007] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 11/18/2011] [Accepted: 11/24/2011] [Indexed: 11/23/2022]
Abstract
Paravalvular regurgitation affects 5% to 17% of all surgically implanted prosthetic heart valves. Patients who have paravalvular regurgitation can be asymptomatic or present with hemolysis or heart failure, or both. Reoperation is associated with increased morbidity and is not always successful because of underlying tissue friability, inflammation, or calcification. Comprehensive echocardiographic imaging with transthoracic and real-time 3-dimensional transesophageal echocardiography is key for characterizing the defect location, size, and shape. For paramitral defects, an antegrade transseptal approach can usually be guided by biplane fluoroscopy, and real-time 3-dimensional transesophageal echocardiography can usually be performed successfully. Alternative approaches to paramitral defects include retrograde transaortic cannulation or transapical access and retrograde cannulation. For oblong or crescentic defects, the simultaneous or sequential deployment of 2 smaller devices, as opposed to 1 large device, results in a higher degree of procedural success and safety because the risk of impingement on the prosthetic leaflets is minimized. Most para-aortic defects can be approached in a retrograde manner and closed with a single device. With careful anatomical assessment, procedural planning, and procedural execution, successful closure rates of 90% or more should be attainable with a low risk of device impingement on the prosthetic valve or embolization.
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Barbash IM, Saikus CE, Ratnayaka K, Faranesh AZ, Kocaturk O, Wu V, Bell JA, Schenke WH, Raman VK, Lederman RJ. Limitations of closing percutaneous transthoracic ventricular access ports using a commercial collagen vascular closure device. Catheter Cardiovasc Interv 2011; 77:1079-85. [PMID: 21234923 DOI: 10.1002/ccd.22941] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/11/2010] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Closed-chest access and closure of direct cardiac punctures may enable a range of therapeutic procedures. We evaluate the safety and feasibility of closing percutaneous direct ventricular access sites using a commercial collagen-based femoral artery closure device. METHODS Yorkshire swine underwent percutaneous transthoracic left ventricular access (n = 13). The access port was closed using a commercial collagen-based vascular closure device (Angio-Seal, St. Jude Medical) with or without prior separation of the pericardial layers by instillation of fluid into the pericardial space ("permissive pericardial tamponade"). After initial nonsurvival feasibility experiments (n = 6); animals underwent 1-week (n = 3) or 6-week follow-up (n = 4). RESULTS In naïve animals, the collagen plug tended to deploy outside the parietal pericardium, where it failed to accomplish hemostasis. "Permissive pericardial tamponade" was created under MRI, and accomplished early hemostasis by allowing the collagen sponge to seat on the epicardial surface inside the pericardium. After successful closure, six of seven animals accumulated a large pericardial effusion 5 ± 1 days after closure. Despite percutaneous drainage during 6-week follow-up, the large pericardial effusion recurred in half, and was lethal in one. CONCLUSIONS A commercial collagen-based vascular closure device may achieve temporary but not durable hemostasis when closing a direct left ventricular puncture port, but only after intentional pericardial separation. These insights may contribute to development of a superior device solution. Elective clinical application of this device to close apical access ports should be avoided.
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Affiliation(s)
- Israel M Barbash
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1538, USA
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Pitta SR, Cabalka AK, Rihal CS. Complications associated with left ventricular puncture. Catheter Cardiovasc Interv 2010; 76:993-7. [DOI: 10.1002/ccd.22640] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 04/28/2010] [Indexed: 11/05/2022]
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Davenport JJ, Lam L, Whalen-Glass R, Nykanen DG, Burke RP, Hannan R, Zahn EM. The successful use of alternative routes of vascular access for performing pediatric interventional cardiac catheterization. Catheter Cardiovasc Interv 2008; 72:392-398. [DOI: 10.1002/ccd.21621] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sorajja P, Cabalka AK, Hagler DJ, Reeder GS, Chandrasekaran K, Cetta F, Rihal CS. Successful percutaneous repair of perivalvular prosthetic regurgitation. Catheter Cardiovasc Interv 2007; 70:815-23. [DOI: 10.1002/ccd.21270] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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The Assessment and Therapy of Valvular Heart Disease in the Cardiac Catheterization Laboratory. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Walters DL, Sanchez PL, Rodriguez-Alemparte M, Colon-Hernandez PJ, Hourigan LA, Palacios IF. Transthoracic left ventricular puncture for the assessment of patients with aortic and mitral valve prostheses: the Massachusetts General Hospital experience, 1989-2000. Catheter Cardiovasc Interv 2003; 58:539-44. [PMID: 12652508 DOI: 10.1002/ccd.10473] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Accurate assessment of suspected prosthetic valve dysfunction is critically important as reoperation carries high risk. Noninvasive methods of hemodynamic assessment of patients with both aortic and mitral mechanical valves continue to be frustrated by the interference created by prosthetic material and direct left ventricular puncture may be required for definitive hemodynamic assessment. We report the hemodynamic and angiographic results and outcomes of 38 consecutive patients with double valve replacement who underwent left ventricular puncture as part of evaluation of possible prosthetic dysfunction. These results were compared with those obtained by noninvasive testing. We found noninvasive assessment alone to be unsatisfactory as measurements of regurgitation and stenosis correlated poorly with those obtained by direct left ventricular puncture. Important information that altered patient management was obtained from invasive assessment in 68% of cases with an acceptable rate of complications. Therefore, hemodynamic and angiographic assessment using transthoracic left ventricular puncture should be entertained in patients with mitral and aortic valve replacement presenting with congestive heart failure and suspected prosthesis dysfunction.
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Affiliation(s)
- Darren L Walters
- Cardiology Division, Medical Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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Zuguchi M, Shindoh C, Chida K, Saito H, Takai Y, Yamada S, Iguchi A, Endo M, Akimoto H, Tabayashi K. Safety and clinical benefits of transsubxiphoidal left ventricular puncture. Catheter Cardiovasc Interv 2002; 55:58-65. [PMID: 11793496 DOI: 10.1002/ccd.10073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We performed a transsubxiphoidal LV puncture (TSLVP) to evaluate left ventricular function in 21 patients with both mechanical prosthetic aortic and mitral valves and successfully obtained hemodynamic information on each patient. Analyzing cardiac hemodynamic information and ventriculographic findings obtained with TSLVP, we concluded that seven of the patients required repair of their prosthetic valves. Five of these seven patients agreed to replacement of their valves, whereas two did not. TSLVP was performed adequately and safely without severe complications, suggesting that this maneuver is easier than that of transapical LV puncture and should be recommended for the assessment of left ventricular hemodynamic functions instead of the transapical LV puncture, especially in patients requiring replacement of two valves.
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Affiliation(s)
- Masayuki Zuguchi
- Department of Radiological Technology, College of Medical Sciences, Tohoku University, Sendai, Japan.
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Ing FF, Fagan TE, Grifka RG, Clapp S, Nihill MR, Cocalis M, Perry J, Mathewson J, Mullins CE. Reconstruction of stenotic or occluded iliofemoral veins and inferior vena cava using intravascular stents: re-establishing access for future cardiac catheterization and cardiac surgery. J Am Coll Cardiol 2001; 37:251-7. [PMID: 11153747 DOI: 10.1016/s0735-1097(00)01091-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The study evaluated the safety and efficacy of stent reconstruction of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IVC). BACKGROUND Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations. METHODS Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic and 13 were completely occluded. Although guide wires were easily passed across the stenotic vessels, occluded vessels required puncture through the thrombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation. RESULTS Following stent placement, the mean vessel diameter increased from 0.9 +/- 1.6 to 7.4 +/- 2.6 mm (p < 0.05). Twenty-one of 28 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repeat catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diameter of 6.4 +/- 2.0 mm. Two vessels were occluded, but they were easily recanalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented vessel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessels (87%) remained patent at follow-up thus far. CONCLUSIONS Stenotic/obstructed IFV and IVC may be reconstructed using stents to re-establish venous access to the heart for future cardiac catheterization and/or surgeries.
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Affiliation(s)
- F F Ing
- Children's Hospital of San Diego, California 92123, USA.
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