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

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

“…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.…”

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

“…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].…”

“…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.…”

“…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].…”

Percutaneous treatment of aortic valve stenosis

“…[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.…”