Left ventricular perforation during cardiac catheterization in a case of severe calcific aortic stenosis. Should we cross the valve?

Transapical access closure: the TA PLUG device

“…A stable guiding rail is missing as the guide wire can only be advanced into the LV in a dead-end fashion and therefore cannot provide a safe and firm support. Further, left ventricular guide wire perforations are repeatedly observed and reported [18]. Overall, the transfemoral approach often represents a trade-off in many respects including the mandatory lower crimping profile with increased shear forces on the device.…”

Myocardial perforation by a guidewire crossing a stenotic aortic valve during cardiac catheterization

“…Adverse risk factors in this study for myocardial perforation with the guidewire appeared to be female sex, age above 70 years, an aortic valve area less than 0.7 cm 2 , and a cardiac index of 2.0 l/min/m 2 or less. Bhatia questioned the indication for crossing heavily stenosized aortic valves invasively, when the hemodynamic data were already known by echocardiography [3]. Friedrich et al discussed the diagnosis and management of significant pericardial effusion or tamponade during cardiac catheterization as a result of accidental perforation of the left ventricle.…”