Abstract
An inadvertent puncture during PTMC in the region where right atrium (RA) and left atrium (LA) have overlapping walls may lead the catheter/needle to perforate the right atrial wall, enter the pericardial space and then enter the LA leading to phenomenon. We describe a case of cardiac perforation resulting in cardiac tamponade during PTMC due to stitching phenomenon, promptly recognized and managed, completed PTMC and referred to surgery for cardiac perforation repair.
Highlights
Cardiac tamponade secondary to cardiac perforation following percutaneous transvenous mitral commissurotomy (PTMC) with an incidence of 0 to 9% in several studies[1], account for half of procedure related mortalities, and is often managed by surgery if hemodynamically unstable
Further after hemodynamically stabilizing the patient a successful PTMC was done through a fresh transseptal puncture and mitral valve was dilated with accura balloon resulting in mitral valve orifice area of 1.7 cm2 by planimetry and gradient across mitral valve reduced to 12/7 mm Hg with trivial mitral regurgitation
The mid septum being an ideal site of transseptal puncture during PTMC is often missed owing to distortion of anatomy in patients with mitral stenosis and under fluoroscopic guidance leads to inadvertent puncture of the aorta, coronary sinus or high lateral/inferior atrial wall[3] where there is no atrial septum in this region and beyond
Summary
Cardiac tamponade secondary to cardiac perforation following percutaneous transvenous mitral commissurotomy (PTMC) with an incidence of 0 to 9% in several studies[1], account for half of procedure related mortalities, and is often managed by surgery if hemodynamically unstable. Though with the advent of Inoue balloon, perforations in left ventricle (LV) have decreased during transseptal puncture for PTMC, sometimes perforations at other sites occur, during or after transseptal puncture even under guidance of trans esophageal echocardiography (TEE)
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