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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Transapical left ventricular access for difficult to reach interventional targets in the left heart
Catheterization and Cardiovascular Interventions, Volume 74, No. 1, Year 2009
Notification
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Description
Objective: Interventional targets may be virtually "excluded" due to vascular access problems or complex previous surgical procedures. This study reviews our experience using transapical ventricular puncture to gain direct access to the systemic ventricle. Patients: Patient 1 (74 years, 2 previous sternotomies), patient 2 (66 years, 5 previous sternotomies), and patient 5 (69 years, 3 previous sternotomies) with prosthetic valves had paravalvular mitral valve leaks. Patient 3 (6.3 years, 2 previous sternotomies) with an extracardiac Fontan conduit, had a significant residual leak after two previous surgical attempts of patch closure of a severely regurgitant right atrioventricular valve. Patient 4 (10 months) had failure of standard ablation of the posteroseptal region of the mitral valve with persistent life-threatening episodes of ventricular tachycardia. Methods: Procedures were performed under general anesthesia. Entry site was percutaneous in three patients and in two (and one conversion) a mini-thoracotomy was used. Sheaths were placed (6 F) using standard Seldinger technique, followed by the procedure as required. Direct surgical closure of the puncture site was done in 4 patients and in patient 3, a percutaneous vascular occlusion device was used. Results: Easy and immediate access was obtained in all patients. The paravalvular leaks were crossed within seconds and completely closed with Amplatzer occluders. In patient 3 the valve was crossed using a Brokenbrough needle and a 12-mm Amplatzer device was placed in the patch leak. Patient 4 was successfully ablated using a 7-F irrigated catheter endo- and epicardially. Complications were in the percutaneous puncture group: in one patient a coronary artery was punctured and in one a hemothorax developed. Conclusion: Direct left ventricular puncture offers a very useful alternative access site in selected patients to reach 'inaccessible' targets for certain percutaneous interventions in patients where standard approaches may be impossible or difficult. © 2009 Wiley-Liss, Inc.
Authors & Co-Authors
Brown, Stephen C.
South Africa, Bloemfontein
University of the Free State
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Boschoff, D. E.
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Rega, Filip R.L.
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Eyskens, Bénédicte
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Budts, Werner I.H.L.
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Heidbuchel, H.
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Meyns, Bart P.
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Gewillig, Marc H.
Belgium, Leuven
Ku Leuven– University Hospital Leuven
Statistics
Citations: 63
Authors: 8
Affiliations: 2
Identifiers
Doi:
10.1002/ccd.21939
ISSN:
15221946
e-ISSN:
1522726X
Research Areas
Health System And Policy