Percutaneous transhepatic mitral commissurotomy

Punamiya, Kirti; Beekman, Robert H.; Shim, David; Muller, David W.M.

doi:10.1002/(sici)1097-0304(199610)39:2<204::aid-ccd22>3.0.co;2-f

Cited by 11 publications

(4 citation statements)

References 4 publications

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“…Percutaneous transhepatic access has been well utilized in pediatric literature including diagnostic and interventional cardiac catheterizations, pacemaker placement, and electrophysiological procedures, as well as central access for hemodialysis [7,8], total parenteral nutrition [8], and chemotherapy [6, [9][10][11][12][13][14][15]. The large caliber of hepatic veins makes them well suited to accommodate sheaths, though the site may offer less compressibility for hemostasis.…”

Section: Discussionmentioning

confidence: 99%

Transhepatic Vascular Access for Implantation of a Watchman Left Atrial Appendage Closure Device

Morcos

Tahii

Bansal

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Transhepatic Vascular Access for Implantation of a Watchman Left Atrial Appendage Closure Device

Morcos

Tahii

Bansal

et al. 2018

Reports

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“…After you are certain that the hepatic vein has been reached, introduce the guide wire, dilator and sheath and follow the usual steps to perform the catheterization and the intervention 2,3 . 2) Puncture at the level of the median axillary line below the ribs, slightly directing the needle upwards and backwards towards the spine 4,5 . Employ extra care to avoid puncturing the gallbladder.…”

Section: Discussionmentioning

confidence: 99%

Fechamento percutâneo de comunicação interatrial por punção trans-hepática

Oliveira¹,

Paupério²,

Oliveira³

et al. 2006

Arq. Bras. Cardiol.

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absent, and that it continued as an azygos towards the superior vena cava (SVC). We then punctured the right internal jugular vein and positioned the guide wire into the left inferior pulmonary vein. We then performed all the classic steps to close the ASD, without succeeding in obtaining a good position to release the prosthesis. In view of this, the procedure was interrupted, and re-planned. After obtaining the authorization of the patient and her parents, the procedure was carried out two weeks later by transhepatic puncture of the hepatic vein following the steps below: 1) General anesthesia with endotracheal tube. 2) Transesophageal echocardiogram. 3) Abdominal ultrasound. 4) IV cephalothin 2.0 grams. 5) Preparation of the region of the right hypochondrium and transhepatic puncture in the upper part of the inferior third of the liver at the level of the anterior axillary line using a Chiba 0.018 needle (Cook Inc.) (fi gure 2). The needle was positioned in parallel to the fl oor of the hemodynamics room and directed towards the spine. It was kept 2 cm away from it. The stylet was removed and a 5 ml-syringe with nonionic contrast medium was connected. The needle was slowly withdrawn and we aspirated until blood began to fl ow. At this point, we manually injected a small amount of contrast medium, and confi rmed the position in the hepatic vein (fi gure 3). A 0.035 guide wire was then introduced and positioned in the right atrium. We then performed the dilation with a 7F introducer, then introduced the 7F hemaquet, administered 5,000 U/kg of IV heparin, measured the pressures with a multipurpose catheter, positioned the catheter in the left superior Percutaneous atrial septal defect (ASD) closure is done by inferior vena cava (IVC) routinely. Occasionally this access is not possible due to obstruction or congenital absence of IVC. This case report shows the percutaneous implantation of an Amplatzer device to close large ASD in a patient with congenital absence of IVC. The procedure was done by a transhepatic punction of the hepatic vein with a Chiba needle (Cook Inc.) with no complications, taking the same amount of time, as the usual access. The transhepatic punction is a good option to central venous access in patients without other alternatives. The hepatic veins are large which make it possible to use large sheaths safely, even in neonates with low weight. This technique should be remembered, when it is impossible to use the usual venous access. CASE REPORTAn eighteen-year-old female patient was referred for percutaneous closure of atrial septal defect (ASD). On physical examination she had signs of right ventricle enlargement, fi xed splitting of the second heart sound, ejection systolic murmur in the upper left sternal edge (LSE) and mesodiastolic murmur in the lower LSE.Supplementary tests evidenced sinus rhythm and second degree right branch block on electrocardiogram, slight increase of heart area on thorax x-ray, and OS-ASD with 18 mm of diameter on transesophageal echocardiogram (TE-ECHO) (fi gure 1...

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“…Prior studies of the use of transhepatic venous access in cardiac catheterization, in portal vein sampling, and for chronic indwelling central venous access report complication rates of Ͻ5% [1][2][3]8,9]. Many of the bleeding complications were in patients with an underlying coagulopathy [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous transhepatic access has been previously described for chronic indwelling central venous access, cardiac catheterization, balloon mitral commissurotomy, and portal vein sampling [1][2][3][4][5][6][7]. Complications of transhepatic access include bleeding, infection, hepatic injury, intraabdominal hemorrhage, perforation of the gallbladder, bile effusion in the pleural space, and bowel perforation [1][2][3][8][9]. We describe two transplant patients who have undergone repetitive percutaneous transhepatic venous access for myocardial biopsies and right heart catheterization.…”

Section: Introductionmentioning

confidence: 99%