Perforation Of Right Ventricle Research Articles

Acute Pericardial Effusion from Pacemaker Lead Perforation of Right Ventricle Identified on Bedside Emergency Department Ultrasonography

Introduction and Objective Cardiac pacemakers and Implantable Cardioverter-Defibrillators (ICD) are devices used to treat a range of cardiac dysrhythmias. Symptomatic cardiac perforation may occur in as many as 4.2% of pacemaker or ICD placements with 1.2% of pacemaker or ICD placements leading to clinically significant pericardial effusion. Acute onset of symptoms within 24 hours of device placement due to cardiac perforation is particularly rare, with a paucity of reported cases. This report describes a case of bedside Emergency Department (ED) ultrasound identifying an acute onset of pericardial effusion following cardiac pacemaker placement in an 85-year-old woman who experienced pleuritic and oscillating chest pain. Case Presentation An 85-year-old woman with a past medical history of hypertension, diabetes and dual-chamber pacemaker placement two days ago presented to the ED with pleuritic and oscillating chest pain. Initial bedside Point of Care Ultrasound (POCUS) exam, performed by the emergency department attending, revealed a moderate pericardial effusion with evidence of a pacemaker lead perforation through the right ventricular myocardium. Lead perforation and effusion were confirmed via formal transthoracic echocardiogram. Minutes later, the patient was treated with a right ventricle lead repositioning procedure and recovered uneventfully. Conclusion Symptomatic cardiac perforation due to pacemaker or ICD placement is rare, with a range of potential complications which typically occur weeks to months after placement. This case demonstrates the utility of POCUS exam for patients presenting to the ED for non-specific chest pain as it facilitated the timely diagnosis of an atypical presentation of ICD-induced wall perforation.

A novel technique to avoid perforation of the right ventricle by the temporary pacing lead during transcatheter aortic valve implantation.

Cardiac tamponade is a life-threatening complication during transcatheter aortic valve implantation (TAVI), often caused by perforation of the right ventricle (RV) by the temporary pacemaker used for rapid pacing during valve deployment. We aimed to assess the feasibility of performing rapid pacing while maintaining inflation of the pacing lead balloon in the RV during TAVI. Among 749 consecutive patients who underwent TAVI with SAPIEN XT valves between October 2013 and July 2015, 726 treated using rapid pacing with a transvenous balloon-tip lead were enrolled in our study, and were stratified into three groups according to the extent of balloon inflation in the RV as follows: full inflation (n = 100), partial inflation (n = 196), and deflation (n = 430). We compared the following clinical outcomes: pacing lead-related RV perforation, rapid pacing failure, valve malpositioning due to rapid pacing failure, device success, and 30-day mortality. Pacing lead-related RV perforation occurred only in patients in the deflation group (6 cases, 1.4%), but the differences among the groups were not statistically significant (p = 0.13). Rapid pacing failure, but no valve malpositioning, occurred most frequently in patients in the full inflation group (4.0% vs. 0.5% in the other groups, p = 0.004). The rate of device success (> 94%) and the 30-day mortality (2.0%) were similar among the three groups. Partial inflation of the balloon of the pacing lead may reduce the risk of RV perforation without increasing the risk of pacing failure or valve malpositioning.

Clinical case of asymptomatic perforation of right ventricle during permanent pacemaker implantation

The present paper discusses one of the serious complications of electrocardiostimulator implantation: electrode perforation of the right ventricle wall, a condition that can occur in both the early and late postoperative periods. The latter occurs less frequently, and the patient may be asymptomatic; this results in an adverse effect on the patient’s quality of life and disease prognosis. Knowledge about the symptoms of late perforation and algorithms to examine patients suspected to have this complication contributes to timely surgical intervention as well as prevention of heart failure progression and fatal outcomes. This paper describes a clinical case of right ventricular perforation 1.5 years after electrocardiostimulator implantation, wherein, despite the absence of pronounced clinical symptoms, the patient was successfully diagnosed with pacemaker testing, Holter diagnostics, echocardiography and computed tomography of thoracic organs. Myocardial damage was accompanied by small left-hand bone-diaphragm hydrotorax and hydropericardium. The risk factors of perforation in the present case were low body weight and age. In the course of the surgical operation performed with the exact observance of the chosen technique, the integrity of the myocardium of the right ventricle and the function of the electrocardiostimulator were restored. Thus, the life-threatening consequences of the described complication were prevented.Received 12 September 2019. Revised 20 December 2019. Accepted 23 December 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

Cardiac Embolism Followed by Perforation of Right Ventricle after Percutaneous Vertebroplasty

Cardiac Embolism Followed by Perforation of Right Ventricle after Percutaneous Vertebroplasty

Transcatheter and minimally invasive surgical left ventricular reconstruction for the treatment of ischaemic cardiomyopathy: preliminary results†.

Adverse remodelling of the left ventricle (LV) after myocardial infarction (MI) results in a pathological increase in LV volume and reduction in LV ejection fraction (EF). We describe the preliminary results of a novel, multicentre, combined transcatheter and minimally invasive technique to reconstruct the remodelled LV by plication and exclusion of the scar, and to reduce the excess volume, resulting in decreased wall stress and increased EF. A novel hybrid transcatheter technique that relies on microanchoring technology (Revivent TC™ System, BioVentrix Inc., San Ramon, CA, USA) was used. The LV is reconstructed without the use of extracorporeal circulation by plication of the fibrous scar. This is achieved by implantation of a series of internal and external microanchors brought together over a PEEK (poly-ether-ether-ketone) tether to form a longitudinal line of apposition between the LV free wall and the anterior septum. Internal anchors are deployed by a transcatheter technique on the right side of the ventricular septum through the right internal jugular vein. Paired external anchors are advanced through a left-sided minithoracotomy and deployed on the LV epicardium. A specialized force gauge is used to bring these 'right ventricle (RV)-LV' anchors together under measured compression forces. LV-LV' anchor pairs through the LV apex beyond the distal tip of the RV complete the reconstruction. Patients who were considered eligible for the procedure presented with symptomatic heart failure (New York Heart Association class ≥II) and ischaemic cardiomyopathy (EF <40%) after anteroseptal MI. All patients had a dilated LV with either an a- or dys-kinetic scar in the anteroseptal wall and apex of ≥50% transmurality. Between October 2016 and April 2017, 9 patients (8 men, 1 woman; mean age 60 ± 8 years) were operated on in 2 Dutch centres. Procedural success was 100%. On average, 2.6 anchor pairs were used to reconstruct the LV. Comparing echocardiographic data preoperatively and directly postoperatively, LV ejection fraction increased from 28 ± 8% to 40 ± 10% (change +43%, P < 0.001) and LV volumes decreased LV end-systolic volume index 53 ± 8 ml/m2 to 30 ± 11 ml/m2 (change -43%, P < 0.001) and LVEDVI 75 ± 23 ml/m2 to 45 ± 6 ml/m2 (change -40%, P = 0.001). In 1 patient, an RV perforation occurred which necessitated conversion to full sternotomy. One patient underwent a postoperative revision because of RV restriction. After the removal of 1 'RV-LV' anchor pair, the patient recovered completely. Hospital mortality was 0%. The median duration of intensive care unit stay was 2 days [interquartile range (IQR) 1-46 days], and the median length of hospital stay was 9 days (IQR 3-57 days). Hybrid transcatheter LV reconstruction is a promising novel treatment option for patients with symptomatic heart failure and ischaemic cardiomyopathy after anteroseptal MI. The early results demonstrate that the procedure is safe and results in a significant improvement in EF and reduction in LV volumes in the early postoperative period.

Right ventricular perforation caused by pulmonary artery catheter at intensive care unit

Pulmonary artery catheter (PAC) is considered the useful hemodynamic monitoring tool in cardiac surgery and intensive careunit (ICU). Placement of PAC has potential risks of complications, though. A various type of complications have been reported.However, right ventricular perforation by PAC is rare finding. In this case, a 68-year-old woman with rheumatic aortic stenosisand mitral stenosis was planned double valve replacement. PAC was not advanced in pulmonary artery during surgery. Aftertransferred ICU, PAC was advanced into right ventricle (RV) with ballooning. A large amount of bleeding and hemodynamicinstability was developed, and then, reoperation was decided. After median sternotomy, surgeon detected the protruding PACtip from the free wall of RV. Direct suture was performed, and catheter tip was withdrawn back into the RV cavity. It is importantto keep in mind that RV perforation could arise after PAC insertion and PAC should be gently handled.

PERFORATING THE ATRETIC PULMONARY VALVE IN NEONATES USING CORONARY TOTAL OCCLUSION HARDWARE

Interventional therapy is possible in selected patients with of pulmonary atresia with intact ventricular septum (PA- IVS). Among the various interventional options available, radiofrequency and laser assisted perforation may be more successful, but have substantial cost and expertise involved. On the other hand coronary hardware used to cross totally occluded coronary arteries is often readily available in catheterization labs and interventional cardiologists are familiar with their use. We describe the technique of mechanical catheter pulmonary valve (PV) perforation using currently available coronary hardware meant for coronary chronic total occlusion. Eight neonates diagnosed to have PA- IVS underwent PV perforation using the coronary hardware. All these babies had a well formed right ventricle (RV) with no evidence of RV dependent coronary circulation. After complete echocardiographic evaluation and an informed parental consent, patients were electively intubated, mechanically ventilated, adequately heparinized and were put on intravenous prostaglandin infusion. Basic steps involved localizing the atretic segment and coaxial alignment of catheters using biplane fluoroscopy, crossing the atretic segment with soft end of perforating guide wire, stabilizing the assembly, followed by graded balloon dilatation never exceeding 130% of pulmonary annulus. The PV was crossed retrogradely in one patient when antegrade approach was not possible. Procedure was successful in 7 / 8 cases (89.5%). Valve opening was achieved in all patients with immediate fall in RV systolic pressures. One neonate died following surgery after catheter induced RV perforation. All surviving cases were discharged from hospital in good general condition with no evidence of heart failure and room air saturation of > 85 %. No patient required an additional procedure over a short follow up period. With appropriate patient and hardware selection, PV perforation using readily available coronary hardware is feasible in PA-IVS.

First human use of a novel epicardial access needle embedded with a real time pressure/frequency monitoring of thoracic structures to facilitate epicardial access

Introduction: Epicardial (epi) ablation represents an adjunctive strategy for the treatment of challenging arrhythmias. Major complications may occur during epi access since the may inadvertently puncture the right ventricle (RV), the pleural space or the lung. We sought to evaluate if a new access epi reduce the risk for RV puncture and complications. Methods: 7 consecutive pts with epi arrhythmias (6 ventricular, 1 supraventricular) were enrolled. Epi access with a novel needle embedded with a tip sensor able to record beat-to-beat pressure waveform was utilized. Successful epi access was confirmed by fluoroscopy, contrast injection and visualization of the guidewire looping around the epi border of the heart. In 4 cases the epi access was obtained by an expert operator, while in 3 cases the access was obtained by a less experienced operator. Results: Successful epi access was obtained in all cases. No acute and delayed complications occurred. Mean Pericardial pressure/pulsation was 3.5±1.3 mmHg while mean RV pressure was 15±4 mmHg (p=0.001). Pressure monitoring identified pericardial wire access position in 75% of the attempts and was able to identify RV puncture in 100% of the cases. 3 false negative readings were recorded, where the guidewire was within the pericardial space while the tip pressure was indicating differently. Unintended RV puncture occurred in 50% of the cases (always detected). Unintended RV puncture occurred more often in the less experienced operator (6 times vs 2 times, P<0.05). ![Figure][1] Conclusion: Real time pressure monitoring identifies successful pericardial access and RV perforation. This information would be important to facilitate epi access to less experienced operators [1]: pending:yes

Perforation of right ventricle with cardiac tamponade following pacemaker implantation

Perforation of right ventricle with cardiac tamponade following pacemaker implantation

Delayed perforation of right ventricle with cardiac tamponade: a complication of pacemaker implantation

We report a case of delayed cardiac tamponade that resulted from pacemaker implantation in the emergency room of a large urban hospital. A 19-year-old male patient with a pacemaker implanted 10 days earlier suffered from delayed perforation of the right ventricle with cardiac tamponade. A review of the literature revealed that cardiac tamponade is a rare complication of pacemaker implantation. Pacemakers should only be implanted by physicians with relevant experience, and emergency room physicians should be aware of the possibility of the associated complications and be prepared to treat them.

A review of pulmonary artery catheterization in 6,245 patients.

From July 1977 to December 1982, 6,245 patients requiring cardiac and noncardiac operations had pulmonary artery (PA) catheterizations for perioperative monitoring. Their ages ranged from 4 to 94 years. PA catheters were inserted through the external or internal jugular vein in 6,146 patients, while arm veins were used in 99 patients. Complications included persistent PVCs requiring therapy in 193 (3.1%), right bundle branch blocks in three (0.048%), left bundle branch and complete heart block each in one patient (0.016%), intrapulmonary hemorrhage in four (0.064%), minor pulmonary infarcts in four (0.064%), perforation of right ventricle in one (0.016%), and death from uncontrollable pulmonary hemorrhage in one patient (0.016%). This investigation reveals a low incidence of morbidity associated with PA catheterization.

Perforation of right ventricle by polyethylene catheter.

Perforation of right ventricle by polyethylene catheter.