Pericardial Patch Repair of Aortic Cusp Perforation Caused by Cardiac Catheterization

Denyer, Michael H.; Elliott, Charles M.; Robicsek, Francis

doi:10.1111/j.1540-8191.1988.tb00233.x

Cited by 12 publications

(15 citation statements)

References 1 publication

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“…In the literature, there are 2 cases of aortic regurgitation after complicated diagnostic heart catheterization. 1,2 We carried out a systematic review of all cases of aortic valve replacement performed within 2 months of a PCI at the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada, between January 2004 and January 2010. During this period, 18 354 PCIs were performed (93% radial access), and only 1 additional case was uncovered.…”

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confidence: 99%

Severe Aortic Regurgitation After Transradial Percutaneous Coronary Intervention

Ong

Bagur

Barbeau

et al. 2011

Circ: Cardiovascular Interventions

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A 60-year-old man presented to a community hospital with new-onset shortness of breath after a 2-hour episode of typical chest pain. The ECG showed anteroseptal and inferior wall Q-waves. Serum troponin T levels were negative. An echocardiogram revealed anterior wall hypokinesia with left ventricular ejection fraction of 40% and no signs of valvular disease. The patient was transferred to our center for coronary angiography. Arterial access was obtained from the right radial artery. The angiogram showed mild disease of the left coronary artery and a right coronary artery (RCA) arising from the left coronary sinus. The RCA was extremely difficult to cannulate; nonselective injections revealed a long and severe stenosis of the mid segment ( Figure 1 and Movie 1). After many unsuccessful attempts to cannulate the RCA with different guiding catheters, the operator decided to engage first the left coronary artery with an Amplatz 2 guiding catheter. A BMW Universal II guide wire was advanced into the left anterior descending artery (LAD) for better stability. This approach made it possible to gently pull the guiding catheter back and to position its tip at the RCA ostium. This maneuver permitted the operator to advance a Choice PT guide wire into the RCA (Figure 2 and Movie 2). However, because the system was extremely unstable, the Amplatz catheter was removed and replaced with a 6F Multipurpose guiding catheter. The RCA was engaged using the same approach as described previously for the Amplatz catheter. Balloon predilatation was then performed, and selective cannulation of the RCA was made possible after removal of the LAD guide wire, with the RCA balloon still inflated. Successful percutaneous coronary intervention (PCI) with stenting of the mid RCA was then carried out ( Figure 3 and Movie 3). Cardiac MRI was performed immediately after PCI to investigate the reason for anterior wall hypokinesis in the presence of a normal LAD. Prior nontransmural anterior wall myocardial infarction and mild aortic regurgitation were present. The following day, a new diastolic regurgitation murmur was noted, and a transthoracic echocardiogram showed a new severe aortic regurgitation (Figure 4 and Movie 4). To better characterize the nature of this newly diagnosed valvulopathy, a 3-dimensional transesophageal echocardiogram was performed. The aortic regurgitation was the result of a tear and perforation of the left aortic leaflet ( Figure 5 and Movies 5 and 6). Consequently, the patient underwent aortic valve replacement. The anatomopathological examination confirmed the traumatic laceration of the left aortic leaflet (Figure 6). Figure 7 nicely depicts how the tip of the multipurpose guiding catheter was pressing on the aortic cusp during the procedure. This suggests that catheterinduced direct traumatic damage was the most probable mechanism of aortic regurgitation in this patient.Traumatic aortic valve laceration is a rare complication after cardiac catheterization. In the literature, there are 2 cases of aortic regurgitation a...

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confidence: 99%

Severe Aortic Regurgitation After Transradial Percutaneous Coronary Intervention

Ong

Bagur

Barbeau

et al. 2011

Circ: Cardiovascular Interventions

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“…Aortic cusp perforation is a rarely reported complication of invasive cardiac procedures. It includes diagnostic cardiac catheterization [9], radiofrequency ablation [10], percutaneous aortic balloon valvuloplasty [11,12] and directional coronary atherectomy [13]. Iatrogenic aortic valve injury can occur at any of the three aortic valve cusps, depending on the proximity of the aortic valve to the other adjacent cardiac structures and the type of the previous periaortic operation [8].…”

Section: Discussionmentioning

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A case of iatrogenic aortic valve leaflet perforation after closure of a ventricular septal defect

Woo

Koh

Chang

et al. 2010

Int J Cardiovasc Imaging

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Aortic regurgitation caused by leaflet perforation is most frequently seen in association with infective endocarditis that involves the aortic valve. There have been occasional reports of iatrogenic aortic regurgitation caused by aortic valve injury after cardiac surgery with the use of the transaortic approach or invasive cardiac procedures. Suture-related aortic valve injury can develop during periaortic cardiac surgery, but this has been very rarely reported. Inadvertent injury to an aortic valve leaflet caused by a stitching needle or surgical forceps can produce leaflet perforation with aortic regurgitation. This report describes a case of aortic regurgitation that was caused by iatrogenic aortic valve leaflet perforation, and this occurred in a 22-year-old woman who underwent repair of a ventricular septal defect (VSD) 15 years previously. Transthoracic echocardiography (TTE) showed a defect located at the aortic annulus close to the infundibular septum on a two-dimensional echocardiographic study and we observed an eccentric jet flow into the left ventricle in early diastole on the continuous wave and color flow Doppler studies. A small perforation in the body of the right aortic cusp and mild to moderate aortic regurgitation were confirmed by the use of transesophageal echocardiography (TEE) and ascending aortography.

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“…1,[6][7][8][9][10][11][12][13] The site of cusp injury is related to the location of the previous peri-aortic operation. 1,[6][7][8][9][10][11][12][13] The site of cusp injury is related to the location of the previous peri-aortic operation.…”

Section: Etiology and Location Of Aortic Valve Perforationmentioning

confidence: 99%

“…1,[3][4][5][8][9][10][11][12][13][14][15][16] The major strength of the recently introduced RT3DTEE is its ability to provide precise spatial orientation of cardiac anatomy; it also shows the interstructural spatial relationships and displays the aortic and mitral valve anatomy from the surgeon's perspective. 1,[3][4][5][8][9][10][11][12][13][14][15][16] The major strength of the recently introduced RT3DTEE is its ability to provide precise spatial orientation of cardiac anatomy; it also shows the interstructural spatial relationships and displays the aortic and mitral valve anatomy from the surgeon's perspective.…”

Section: D and Real Time 3dtee In Diagnosing Av Perforationmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Two-dimensional transthoracic echocardiography (2DTTE) and transesophageal echocardiography (TEE) with Doppler and color flow imaging are the standard techniques utilized to define the anatomic fault and to quantify AR. Aortic valve (AV) perforation may be caused by infective endocarditis, surgical, or catheter-related iatrogenic injuries, chest trauma and spontaneous rupture of a leaflet fenestration.…”

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Real Time Three‐Dimensional Transesophageal Echocardiographic Evaluation of Aortic Valve Perforation

Bansal

Chandrasekaran

2014

Echocardiography

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Pericardial Patch Repair of Aortic Cusp Perforation Caused by Cardiac Catheterization

Abstract: A case of acquired aortic insufficiency due to perforation of the aortic leaflet at the time of the diagnostic heart catheterization is presented. The situation was remedied by repairing the perforated leaflet using a pericardial patch.

Cited by 12 publications

References 1 publication

Severe Aortic Regurgitation After Transradial Percutaneous Coronary Intervention

Severe Aortic Regurgitation After Transradial Percutaneous Coronary Intervention

A case of iatrogenic aortic valve leaflet perforation after closure of a ventricular septal defect

Real Time Three‐Dimensional Transesophageal Echocardiographic Evaluation of Aortic Valve Perforation

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