Aortic Leaflet Perforation During Radiofrequency Ablation

Seifert, Mark J.; Morady, Fred; Calkins, Hugh; Langberg, Jonathan J.

doi:10.1111/j.1540-8159.1991.tb02732.x

Cited by 47 publications

(21 citation statements)

References 3 publications

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“…More serious complications in using the retrograde approach is the potential for damage to the aortic and mitral valves. Aortic leaflet rupture [13], a 12% incidence of mild mitral regurgitation, and a 30% incidence of aortic regurgitation [14] have been reported with the retrograde transaortic technique. Rare reports of coronary artery dissection with the retrograde technique have also been documented [10].…”

Section: Discussionmentioning

confidence: 98%

Ablation of Atrial Insertion Sites of Left-Sided Accessory Pathways in Children: Efficacy and Safety of Transseptal Versus Transaortic Approach

et al. 1997

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Left-sided accessory pathways are a common substrate for supraventricular tachycardias in children. A transseptal approach to catheter ablation has been primarily advocated in this population because of concerns regarding vascular injury, aortic, and mitral valvular damage using the transaortic approach via retrograde femoral arterial cannulation. However, the transaortic approach is simpler and may be less time consuming. We, therefore, compared the efficacy and safety of the transseptal vs the transaortic approach in 49 consecutive pediatric patients. In both groups, the atrial insertion site of the accessory pathways was targeted. Postprocedure two-dimensional and Doppler echocardiograms were obtained in all patients. The transseptal and transaortic groups were similar in age (15.8 +/- 1.6 vs 13.5 +/- 3.6 p NS), manifest vs concealed (9/5 vs 20/15), and number of radiofrequency lesions (4 vs 6). Fluoroscopy time was significantly shorter in the transaortic group (33 vs 58 min, p < 0.05). The only evident complications were mild mitral regurgitation seen in two patients (one in each group). Two patients in the transseptal group had recurrence of tachycardia on follow-up and were successfully ablated by the transaortic method. In this series from a single center, a transaortic approach to ablation of left-sided accessory pathways in children older than 4 years was as effective as a transseptal approach.

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Section: Discussionmentioning

confidence: 98%

Ablation of Atrial Insertion Sites of Left-Sided Accessory Pathways in Children: Efficacy and Safety of Transseptal Versus Transaortic Approach

et al. 1997

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“…In this study, both patients who developed aortic insufficiency underwent quite short procedures, with two and seven energy applications, respectively, and the number of aortic passages was therefore low. Individual susceptibility may be of decisive importance,15 although the anatomy of the valvar leaflets and the dimensions of the left ventricle were normal in our two patients. Occasional cases of aortic insufficiency caused by radiofrequency procedures have been reported in earlier studies,3 25 and the risk seems to be higher in children and adolescents.…”

Section: Discussionmentioning

confidence: 55%

Frequency and long term follow up of valvar insufficiency caused by retrograde aortic radiofrequency catheter ablation procedures

Olsson

Darpö

Bergfeldt

et al. 1999

Heart

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Objective-To assess the frequency of valvar complications caused by left sided radiofrequency catheter ablation using the retrograde aortic technique. Methods-179 patients (118 male) with a mean (SD) age of 43 (17) years underwent 216 procedures at one centre. The target of the ablation was an accessory atrioventricular pathway in 144 patients, the atrioventricular junction in 29 patients, and a ventricular tachycardia in six patients. In 25 patients structural heart disease was identified before the procedure (ischaemic heart disease 10, cardiomyopathy nine, valvar three, other three). Echo/ Doppler examinations were performed the day before the procedure and within 24 hours postablation; the investigations were all reviewed by the same investigator. Patients with identified valvar injury caused by the procedure were followed for 42 (7) months. Results-Valvar injury caused by the ablation procedure was identified in four young (age 30 (8) years), otherwise healthy patients with left lateral atrioventricular accessory pathways. Mild mitral insuYciency with a central regurgitation jet was detected in two patients and remained unchanged at follow up. Mild aortic insufficiency was detected in another two patients. In one of these the regurgitation jet was central and remained unchanged at follow up. In one patient the regurgitation jet was located between the noncoronary and left cusps in relation to a loosely attached structure. Both the structure and the valvar regurgitation disappeared during follow up. No clinical complications occurred in any of the patients during follow up. Conclusion-In this study, the frequency of valvar complications after left sided radiofrequency catheter ablation using the retrograde aortic technique was 1.9%. (Heart 1999;81:292-296)

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“…Aortic cusp perforation is a rarely reported complication of invasive cardiac procedures. It includes diagnostic cardiac catheterization [9], radiofrequency ablation [10], percutaneous aortic balloon valvuloplasty [11,12] and directional coronary atherectomy [13]. Iatrogenic aortic valve injury can occur at any of the three aortic valve cusps, depending on the proximity of the aortic valve to the other adjacent cardiac structures and the type of the previous periaortic operation [8].…”

Section: Discussionmentioning

confidence: 99%

A case of iatrogenic aortic valve leaflet perforation after closure of a ventricular septal defect

Woo

Koh

Chang

et al. 2010

Int J Cardiovasc Imaging

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Aortic regurgitation caused by leaflet perforation is most frequently seen in association with infective endocarditis that involves the aortic valve. There have been occasional reports of iatrogenic aortic regurgitation caused by aortic valve injury after cardiac surgery with the use of the transaortic approach or invasive cardiac procedures. Suture-related aortic valve injury can develop during periaortic cardiac surgery, but this has been very rarely reported. Inadvertent injury to an aortic valve leaflet caused by a stitching needle or surgical forceps can produce leaflet perforation with aortic regurgitation. This report describes a case of aortic regurgitation that was caused by iatrogenic aortic valve leaflet perforation, and this occurred in a 22-year-old woman who underwent repair of a ventricular septal defect (VSD) 15 years previously. Transthoracic echocardiography (TTE) showed a defect located at the aortic annulus close to the infundibular septum on a two-dimensional echocardiographic study and we observed an eccentric jet flow into the left ventricle in early diastole on the continuous wave and color flow Doppler studies. A small perforation in the body of the right aortic cusp and mild to moderate aortic regurgitation were confirmed by the use of transesophageal echocardiography (TEE) and ascending aortography.

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Aortic Leaflet Perforation During Radiofrequency Ablation

Cited by 47 publications

References 3 publications

Ablation of Atrial Insertion Sites of Left-Sided Accessory Pathways in Children: Efficacy and Safety of Transseptal Versus Transaortic Approach

Ablation of Atrial Insertion Sites of Left-Sided Accessory Pathways in Children: Efficacy and Safety of Transseptal Versus Transaortic Approach

Frequency and long term follow up of valvar insufficiency caused by retrograde aortic radiofrequency catheter ablation procedures

A case of iatrogenic aortic valve leaflet perforation after closure of a ventricular septal defect

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