Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1106-1115 ◽  
Author(s):  
Hao Chen ◽  
Thomas Fink ◽  
Xianzhang Zhan ◽  
Minglong Chen ◽  
Lars Eckardt ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Right Atrium ◽  
Surgical Repair ◽  
Clinical Course ◽  
Interventional Cardiology ◽  
Ascending Aorta ◽  
Transseptal Puncture ◽  
The Right

Aims Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root puncture (ARP) due to TSP. Methods and results All patients with ARP were retrospectively collected from seven hospitals. Aortic root puncture was identified and classified regarding angiographical and intraoperative findings in cardiac surgery: (i) TSP from the right atrium (RA) to the non-coronary sinus (NCS), (ii) TSP from RA to the non-coronary sinutubular junction (STJ), and (iii) TSP from RA to the ascending aorta (AA). A total of 24 patients with inadvertent ARP were identified. In 19 patients, penetration of the aorta was accomplished by the inner dilator, in 5 patients by the complete sheath. Previous cardiac surgery had been performed in six patients. There were 13 RA-to-NCS punctures, 2 RA-to-STJ punctures, and 9 RA-to-AA punctures. No cardiac tamponade (CT) occurred in patients with RA-to-NCS and RA-to-STJ punctures. In 8 of 9 patients with RA-to-AA puncture, CT occurred immediately requiring urgent pericardiocentesis and surgical repair. Two patients died after surgical repair. In the 16 patients without surgical therapy, no shunt from the AR to the RA was observed 3 months after the procedure. Conclusion Aortic root puncture due to mislead TSP via NCS or STJ is usually not associated with a severe clinical course while ARP into the AA via the epicardial space generally leads to CT requiring surgical repair.

Partial Aortic Root Remodelling for Fistula Between the Non-Coronary Sinus and the Right Atrium

2008 ◽  
Vol 17 (3) ◽  
pp. 261-263 ◽  
Author(s):  
Manabu Itoh ◽  
Yukio Okazaki ◽  
Kazuyuki Ikeda ◽  
Koujirou Furukawa ◽  
Satoshi Ohtsubo ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Aortic Root ◽  
Right Atrium ◽  
The Right

M26 How Does the Histology of the Aortic Root and Ascending Aorta Affect Aortic Aneurysm Progression and Surgical Repair?

2021 ◽  
Vol 30 ◽  
pp. S11
Author(s):  
T. Surman ◽  
D. O'Rourke ◽  
J. Finnie ◽  
K. Reynolds ◽  
J. Edwards ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Root ◽  
Surgical Repair ◽  
Ascending Aorta

scholarly journals A fistula from the coronary artery into the right atrium caused by transseptal puncture

2008 ◽  
Vol 29 (20) ◽  
pp. 2472-2472 ◽  
Author(s):  
Akira Tamura ◽  
Shigeru Naono ◽  
Junichi Kadota
Keyword(s):  
Coronary Artery ◽  
Right Atrium ◽  
Transseptal Puncture ◽  
The Right

scholarly journals Surgical repair of massive dilatation of the right atrium with tricuspid regurgitation

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Masaho Okada ◽  
Hirotaka Watanuki ◽  
Kayo Sugiyama ◽  
Yasuhiro Futamura ◽  
Katsuhiko Matsuyama
Keyword(s):  
Tricuspid Regurgitation ◽  
Right Atrium ◽  
Surgical Repair ◽  
The Right

Retrograde Coronary Sinus Perfusion: A New Approach to Cardioplegia Delivery

1990 ◽  
Vol 1 (1) ◽  
pp. 59-64
Author(s):  
Sheri Monsein ◽  
Patria Constancia
Keyword(s):  
Cardiac Surgery ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Patient Population ◽  
New Approach

Retrograde coronary sinus perfusion is a technique being used to deliver cardioplegia during cardiac surgery. This article reviews the history behind its use, the procedure for delivery, and the advantages and limitations that exist in comparison with the standard antegrade infusion of cardioplegia via the aortic root. The complications resulting from the technique of retrograde coronary sinus perfusion are rare. Nursing considerations specific to the potential complications of this patient population are discussed.

scholarly journals Novel technique of repairing right partial anomalous pulmonary venous connection with intact atrial septum using in situ interatrial septum as a flap in a 68-year-old-woman: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Atsushi Morishita ◽  
Ikuo Hagino ◽  
Hideyuki Tomioka ◽  
Seiichiro Katahira ◽  
Takeshi Hoshino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Atrium ◽  
Septal Defect ◽  
Surgical Repair ◽  
Interatrial Septum ◽  
Pulmonary Artery Hypertension ◽  
Right Heart ◽  
Intact Atrial Septum ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

Abstract Background Partial anomalous pulmonary venous connection draining into the right atrium with an intact atrial septum is a very rare clinical entity in the adult population. Partial anomalous pulmonary venous connection must be suspected as a differential diagnosis when the cause of right heart enlargement and pulmonary artery hypertension is unknown. Case presentation This study describes the surgical case of an isolated right partial anomalous pulmonary venous connection to the right atrium in a 68-year-old woman, who underwent tricuspid ring annuloplasty and right-sided maze procedure simultaneously. She had complaints of gradually progressing dyspnea on exertion. However, a diagnosis could not be established despite consultations at multiple hospitals for over a year. Right heart catheterization revealed severe pulmonary artery hypertension with a mean pulmonary artery pressure of 46 mmHg, step-up phenomenon of oxygen saturation at the mid-level of the right atrium with a pulmonary-to-systemic blood flow ratio of 2.4, and a pulmonary vascular resistance of 3.1 Wood Units. As medical treatment with pulmonary artery vasodilator therapy did not improve her symptoms, she underwent surgical repair. An atrial septal defect was created surgically with a curvilinear tongue-shaped cut. The right anomalous pulmonary veins were rerouted through the surgically created atrial septal defect into the left atrium with a baffle comprised of the interatrial septum flap, kept in continuity with the anterior margin and sutured while mobilizing the enlarged right atrium. The patient had an uneventful postoperative course and remains asymptomatic. Conclusions The described surgical technique could be considered an effective alternative for patients undergoing surgical repair for a partial anomalous pulmonary venous connection isolated to the right atrium. The indication for surgery must be judged on a case-by-case basis in these patients with prevalent systemic-to-pulmonary shunting.

scholarly journals Mitral valvuloplasty complicated by catheter perforation of the right atrium and the aortic root

2020 ◽  
Vol 35 (9) ◽  
pp. 2429-2431
Author(s):  
Alessandra Francica ◽  
Alfredo Vicentini ◽  
Giuseppe Faggian ◽  
Francesco Onorati
Keyword(s):  
Aortic Root ◽  
Right Atrium ◽  
Mitral Valvuloplasty ◽  
The Right

scholarly journals Characteristics and long-term outcomes of aortico-left ventricular tunnel

2020 ◽  
Author(s):  
Jing Sun ◽  
Hongxia Qi ◽  
Hongyuan Lin ◽  
Wenying Kang ◽  
Shoujun Li ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Surgical Repair ◽  
Mechanical Valve ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Orifice ◽  
The Right

Abstract OBJECTIVES Aortico-left ventricular tunnel (ALVT) is an extremely rare, abnormal paravalvular communication between the aorta and the left ventricle. Few studies have identified the characteristics and long-term prognosis associated with ALVT. METHODS The data of 31 patients with ALVT from July 2002 to December 2019 were reviewed. Echocardiography was performed in all patients during the follow-up period. RESULTS The median age of the patients was 11.5 years. Bicuspid aortic valve and dilatation of the ascending aorta were found in 13 patients, respectively. The aortic orifice in 20 patients showed a close relation to the right sinus and the right–left commissure. Of the 31 patients, 26 were operated on. Mechanical valve replacement was performed in 4 patients and aortic valve repair, in 6 patients. Ascending aortoplasty was performed in 5 patients and aortic replacement was done in 2 patients. One patient died of ventricular fibrillation before the operation. Follow-up of the remaining 30 patients ranged from 1 to 210 months (median 64 months). There were 4 deaths during the follow-up period: 1 had mechanical valve replacement and 3 did not undergo surgical repair. In the 26 patients without aortic valve replacement, 6 had severe regurgitation and 2 had moderate regurgitation. In the 28 patients without replacement of the ascending aorta, 11 had continued dilatation of the ascending aorta, including those who had aortoplasty. CONCLUSIONS The aortic orifice of ALVT showed an association with the right sinus and the right–left commissure. For patients who did not have surgery, the long-term survival rate remained terrible. Surgical closure should be done as soon as possible after ALVT is diagnosed. The main long-term complications after surgical repair included aortic regurgitation and ascending aortic dilatation.

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