Left ventricular apical puncture: A procedure surviving well into the new millennium

Turgut, Tansel; Deeb, Michael; Moscucci, Mauro

doi:10.1002/(sici)1522-726x(200001)49:1<68::aid-ccd15>3.0.co;2-5

Cited by 9 publications

(6 citation statements)

References 24 publications

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“…They reported no significant complications but stressed the importance of only using a 21-gauge needle for the puncture and a 4F catheter for ventriculography. 8 However, in therapeutic cases, larger sheath sizes are often required. In another case series, 7 8 patients with a varying array of prosthetic valve combinations underwent direct percutaneous LV puncture for a variety of both diagnostic and therapeutic reasons.…”

Section: Discussionmentioning

confidence: 99%

Direct Transthoracic Access to the Left Ventricle for Catheter Ablation of Ventricular Tachycardia

Hsieh

Thomas

Ross

2010

Circ: Arrhythmia and Electrophysiology

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Background-Percutaneous approaches for radiofrequency ablation of ventricular tachycardia (VT) in the left ventricle are typically transarterial retro-aortic, antegrade transmitral via an interatrial septal puncture, or epicardial. However, all 3 approaches may be contraindicated in certain cases. We describe 2 cases of VT ablation in which aortic and mitral valve replacements did not permit utilization of any of these techniques. Methods and Results-Direct access to the left ventricular cavity was achieved with a percutaneous puncture through the intercostal space overlying the apex in the first case and through a left minithoracotomy in the second. A sheath was then inserted via the Seldinger technique, allowing catheter access for mapping and ablation of the VT. After successful ablation, the sheaths were withdrawn and hemostasis was achieved. A large left hemothorax occurred from the left ventricular apical puncture in the first case. Direct closure with a purse-string suture in the second case achieved hemostasis. Conclusions-Direct

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Section: Discussionmentioning

confidence: 99%

Direct Transthoracic Access to the Left Ventricle for Catheter Ablation of Ventricular Tachycardia

Hsieh

Thomas

Ross

2010

Circ: Arrhythmia and Electrophysiology

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“…The assessment of patients with prosthetic valves is difficult [1–3, 15]. Physical examination is neither sensitive nor specific and may be misleading where prosthetic valves are present [16, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Physical examination is neither sensitive nor specific and may be misleading where prosthetic valves are present [16, 17]. Fluoroscopy is useful where abnormal disk motion can be demonstrated either by excessive motion in the case of a paravalvular leak or dehiscence, or with intermittent sticking in the case of obstruction [3]. However, these findings are not proven to be sufficiently sensitive or specific for the assessment of mechanical valves.…”

Section: Discussionmentioning

confidence: 99%

“…The hemodynamic and structural assessment of patients with prosthetic valves may be difficult by noninvasive methods, particularly when dealing with multiple valve replacement [1–3]. Accurate assessment of prosthetic dysfunction in patients presenting with congestive heart failure or hemolysis is important, as reintervention is associated with an increased surgical risk [4–7].…”

Section: Introductionmentioning

confidence: 99%

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Transthoracic left ventricular puncture for the assessment of patients with aortic and mitral valve prostheses: The Massachusetts General Hospital experience, 1989–2000

Walters

Sánchez

Rodriguez-Alemparte

et al. 2003

Cathet Cardio Intervent

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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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“…[31][32][33] Potential disadvantages are related to the left ventricu-lar apical puncture and include adverse ventricular remodeling, left ventricular aneurysm or pseudoaneurysm, pericardial complications, pneumothorax, malignant ventricular arrhythmias, coronary artery injury, and the need for general anesthesia and chest tubes. 27,[31][32][33][34][35] common features of the three approaches The three percutaneous approaches have certain final steps in common. 11,23,30,33 The position of final deployment of the prosthetic valve is determined by the patient's native valvular structure and anatomy and is optimized by using fluoroscopic imaging of the native aortic valve calcification as an anatomical marker, along with guidance from supra-aortic angiography and transesophageal echocardiography.…”

Section: The Antegrade Techniquementioning

confidence: 99%

Percutaneous treatment of aortic valve stenosis

Singh

Shishehbor

Christofferson

et al. 2008

Cleveland Clinic Journal of Medicine

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Left ventricular apical puncture: A procedure surviving well into the new millennium

Cited by 9 publications

References 24 publications

Direct Transthoracic Access to the Left Ventricle for Catheter Ablation of Ventricular Tachycardia

Direct Transthoracic Access to the Left Ventricle for Catheter Ablation of Ventricular Tachycardia

Transthoracic left ventricular puncture for the assessment of patients with aortic and mitral valve prostheses: The Massachusetts General Hospital experience, 1989–2000

Percutaneous treatment of aortic valve stenosis

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