Mechanisms of cardiac perforation leading to tamponade in balloon mitral valvuloplasty

Randomized comparison between Inoue balloon and metallic commissurotome in the treatment of rheumatic mitral stenosis: Immediate results and 6‐month and 3‐year follow‐up

“…More than for severe MR is the importance of the learning curve for cardiac tamponade. In a surgical study about cardiac perforation mechanisms that lead to tamponade after PMV, Joseph et al [41] have proven a direct relation between cardiac perforation and patient age, and an inverse relation between perforation and operator experience. In addition to the risk of ventricular perforation by the guidewire within the LV apex, the need for a lower transseptal puncture than the usual puncture performed in the Inoue technique may increase the risk of perforating the free wall of the right atrium.…”

Mitral valvuloplasty complicated by catheter perforation of the right atrium and the aortic root

“…As far as causes of cardiac perforation during PMC are concerned, several mechanisms have been identified (5) 1) apical tears by straight-tip balloon catheters driven distally during mitral valve dilatation, 2) apical perforations by guidewires introduced through catheters wedged in the apex, 3) tear of the posterior right atrial wall by dilatation of the track produced by very low septal punctures, 4) right ventricular perforation by a pacing catheter, and 5) perforation of the aortic root and adjacent right atrium by sliding up of the trans-septal set. Of note, cardiac perforation was identified to be significantly related to the total experience at the Center and to patient age.…”

Retrograde nontransseptal balloon mitral valvuloplasty by the brachial artery approach

“…A parameter that was taken seriously into account was the anatomy of the interatrial septum, which involved characteristics that have been shown to entail increased risk during transseptal catheterization, because of distortion of the typical landmarks for septal crossing. Problems during transseptal puncture in such conditions have arisen even in centers with extensive experience in transvenous mitral valvuloplasty [5][6][7][8]. Although risks are reported to be lower with application of specific precautions during the procedure [14,15], the prevailing conditions were judged as discouraging in light of our limited experience in such cases, since RNBMV has practically been our exclusive approach to percutaneous mitral valvuloplasty for a number of years.…”

“…In its most widely employed variations, the procedure involves puncture, with or without dilatation, of the interatrial septum for entry into the left atrium [1][2][3][4]. The welldocumented safety of the approach in experienced hands notwithstanding, this procedural step has been associated with a small risk of potentially serious complications [5][6][7][8]. In an effort to obviate the need for transseptal catheterization, an alternative, purely transarterial technique (retrograde nontransseptal balloon mitral valvuloplasty, or RNBMV), based on the use of a specially designed externally steerable left atrial guiding catheter, was developed at the University of Athens, Greece [9,10].…”