Device Closure of Iatrogenic Left Ventricular Perforation Through the Chest Wall
Document Type
Article
Abstract
A 5-year-old girl with dilated cardiomyopathy was placed on venoarterial extracorporeal membrane oxygenation for hypotension. She had a large left pleural effusion, and an 8.3-F pigtail chest tube (CT) was placed in the left pleural space using the Seldinger technique with return of sanguineous fluid. Transthoracic echocardiography identified the catheter placed in the left ventricle (LV) (Figure 1). She was a poor surgical candidate due to systemic coagulopathy and went to the cardiac catheterization lab to close the LV perforation.
Under fluoroscopic and transthoracic echocardiography guidance, 0.035-inch J-wire was advanced inside the CT, into the LV, and across the aortic valve with the tip in the ascending aorta. The CT was exchanged for a 5-F Cook flexor sheath (Cook Medical, Bloomington, Indiana). A 12-mm Amplatzer Vascular Plug II (St. Jude Medical, St. Paul, Minnesota) was placed across the LV myocardium, with the distal disc in the LV, the central disc traversing the myocardium, and the proximal disc in the pericardial space (Figure 2). Angiography demonstrated complete closure of the perforation.
Iatrogenic perforation of the heart during placement of a CT has been rarely reported (1,2), and those cases were repaired with a median sternotomy or thoracotomy. Our case demonstrated successful device closure of a cardiac perforation originating from a CT insertion.
First Page
897
Last Page
898
DOI
10.1016/j.jcin.2019.10.011
Publication Date
4-13-2020
Recommended Citation
McGill M, Aggarwal V, Hiremath G. Device Closure of Iatrogenic Left Ventricular Perforation Through the Chest Wall. Cardiovascular Interventions. 2020 Apr 13;13(7):897-8.